Definition
Swelling in the thyroid gland
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Endemic
Classification
Simple goitre
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vDiffuse-physiological,pubertal,pregnancy
vMultinodular
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Toxic goitrevDiffuse eg.Graves' disease
vMultinodular
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vToxic adenoma
Nontoxic goitre -caused by lithium or other
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autoimmune diseasesParadoxical goiter -enlarged thyroid as a result of
very high intakes of iodine
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Occurs in Japan and China with high intake of
seaweed (50,000 - 80,000 mg/day)
Other classification
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I -palpation struma - in normal posture of head it cannot be
seen,only on palpation
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II-struma is palpative and can be easily seenIII-struma is very big and is retrosternal. Pressure and
compression marks
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Incidence
Daily iodine requirement= 0.1- 0.15mg
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Endemic goitre occur in geographical areaswith iodine-depleted soil, usually regions
away from the sea coast
Common in central Asia and central Africa ,certain
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areas of Australia, including Tasmania and areasalong the Great Dividing Range
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Goitre BeltEtiology
?MC- iodine deficiency
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In countries that use iodized salt, Hashimoto's thyroiditisbecomes the most common cause
?Hypothyroid
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vCongenital hypothyroidism
vIngestion of goitrogens such as cassava
vSide-effects of pharmacological therapy
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?HyperthyroidvGraves' disease
vThyroiditis (acute or chronic)
vThyroid cancer
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Natural HistoryGrowth stimulation
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Diffuse hyperplasia
Active Inactive lobules
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Vascular & hyperplastic NecroticActive follicles Inactive follicles
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Symptoms?Without any hormonal abnormalities, no symptoms
?Anterior neck mass
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?Large masses compression of the local structure
?Difficulty in breathing /swal owing
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?Toxic goitres present with
symptoms such as
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palpitations, hyperactivity,weight loss despite
increased appetite, and
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heat intolerance
Tracheal Compression
Diagnosis
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?Thyroid function test
?Chest X ray
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?Ultrasound /CT Scan?Needle Aspiration / Needle Biopsy
Treatment
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?Antithyroid Medications: Propylthiouracil and
Methimazole
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?I-131?Surgical Therapy
Indications
?Cosmetic
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?Pressure symptoms?Patient anxiety
Types of thyroidectomy
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All thyroid surgeries can be
assembled from three basic
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elements?Total lobectomy
?Isthmusectomy
?Subtotal lobectomy
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Total thyroidectomy=
2 x total lobectomy+ Isthmusectomy
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Subtotal thyroidectomy=2 x subtotal lobectomy+ Isthmusectomy
Near-total thyroidectomy=
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total lobectomy+ subtotal lobectomy+ Isthmusectomy
Lobectomy= total lobectomy+ Isthmusectomy
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Steps of Thyroidectomy
?Exposure-horizontal neck incision, +/- raising of flaps, +/- division of
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strap muscles?Identification of structures -Recurrent and ext. branch of superior
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laryngeal nerve, parathyroid glands?Devascularisation
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vSuperior thyroid arteryvInferior thyroid artery while protecting the supply to the parathyroids
vThyroid ima if present
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?Resection
?Exploration of other pathology
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?ClosureGross and Microscopic Pathology
Multinodular Goiter
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Potential complications after thyroid surgery?Laryngeal Nerve Injury
?Parathyroid Deficit
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?Postoperative Bleeding
?Infrequent Postoperative Complications
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vSympathetic nerve injury- results in the development of Horner'ssyndrome
vChylous fistula- damage to the thoracic duct
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vThyroid storm-resulting from hyperactivity of the thyroid glandhypoparathyroidism
Symptoms
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vTingling in the lips, fingers, and toes
vDry hair, brittle nails, and dry, coarse skin
vMuscle cramps
vLoss of memory
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vHeadachesvSevere muscle spasms (also cal ed tetany)
vConvulsions
Treatment
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vCalcium carbonate
vVitamin D supplements
?After sub total resection thyroxine is given to
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suppress TSH secretion?Radioactive iodine may reduce size of recurrent
nodular goitre
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Prevention
? Introduction of Iodized salts
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? Avoidance of goitrogens (cabbage, turnips,peanuts, soybeans)
? In early (Hyperplastic) stage thyroxine 0.15-
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0.2mg
? Most multinodular goitre are asymptomatic and
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do not require surgery