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Thyroid Gland Hypothyroidism, Thyroiditis & cancer (cancer…

- - - - Fibrous tissue replaces thyroid tissue, leading to a firm thyroid.
        
        Patient may be hypothyroid as well, in which case thyroid hormone should be prescribed.
        
        Surgery may be necessary if complications occur.
    - - presents more commonly as hypothyroidism.
        
        Clinical findings include a goiter that is painless, rubbery and not always symmetrical, which is the main feature of this disease.
        
        managed by replacement with l-thyroxine.
  - - - aetiology:
        staph. aureus,
        strep. pyogenes, pneumoniae,
        E.coli,
        anaerobe
      - treatment:
        hospitalisation,
        antibiotics: cloksacilie or nafilin + gen. iii cephalosporin or gentamicin.
        clindamicin + gen. iii cephalosporin
        abscess drainage
  - - - de Quervaine'a thyroiditis
        
        aetiology: viral, common in F at age 30-60
        presents more commonly as hyperthyroidism.
        
        manifestation:
        symptoms of upper respiratory infection and include asthma , malaise.
        pain over thyroid or refer to lower jaw, ear or occiput.
        fever >40
        symptoms of thyrotoxicosis
        
        treatment: aspirin, steroids, beta blockers, levothyroxine when hypothyrosis
      - usually follows a viral illness; associated with HLA-B35.
        
        Radioiodine uptake is low because thyroid follicular cells are damaged and cannot trap iodine.
        
        Low TSH level secondary to suppression by increased T4 and T3 levels; high ESR.
      - postpartum thyroiditis
    - - painless thyroiditis, silent thyroiditis.
        
        A transient thyrotoxic phase of 2 to 5 months may be followed by a hypothyroid phase.
        
        Similar to subacute (viral) thyroiditis, only without the pain or tenderness of the thyroid gland.
- - - - Follicular Thyroid Cancer (FTC) 10%:
        2nd common,
        histologically mimic normal thyroid,
        undergoes hematogenous spred, and metastasis in lung or bone,
        lymph node involvement is uncommon,
        One variant is the Hürthle cell carcinoma
        not diagnosed by FNA.
      - Papillary Thyroid Cancer (PTC) 90%:
        most common type,
        bimodal incidence: 2 nd and 3rd decades,
        slowly going and spread to the regional lymph nodes,
        may remain indolent for long,
        Positive iodine uptake.
      - risk factors:
        Exposure to radiation,
        Familial history of thyroid carcinoma,
        Thyroid cancer syndrome (Cowden’s disease, familial adenomatous polyposis, Carney complex, Werner syndrome, MEN2)
  - - - risk factors:
        Familial thyroid carcinoma (RET gene),
        MTC+pheochromocytoma+parathyroid tumor=MEN2
      - treatment:
        surgery (total thyroidectomy)
        131I (NO)
        L-Thyroxine (substitutive therapy)
        Chemotherapy (ATC)