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Ch 9: Endocrine Disorders (i) Thyroid Disease - Coggle Diagram
Ch 9: Endocrine Disorders (i) Thyroid Disease
Anatomy of thyroid gland
C5-T1
recurrent laryngeal N passes behind - vulnerable during surgery
Types of thyroiditis
Hashimoto's
high TPO + thyroglobulin abs
de Quervain's
subacute
painful
usually self-limiting but occasionally steroids needed
raised inflamm markers
triggered by viral infection
Reidels'
chronic
hard woody swelling (mimics malignancy)
often need analgesia, usually NSAIDs
Amiodarone induced thyroid disease
can cause hypo or hyper
direct toxic effect
normal TSH + abnormal T4 - often drugs is the cause
other drugs affecting thyroid: steroids, heparin
dDx neck swelling
cystic hygroma
Zenker's diverticulum
lymphadenopathy
salivary gland swelling/tumour
lipoma
thyroglossal cyst
excision = sistrunk procedure
branchial cleft cyst
goitre
carotid body tumour (chemodectoma)
Neck anatomical levels
1A: submental
1B: submandibular
2: upper internal jugular
3: middle internal jugular
4: lower internal jugular
5: posterior triangle
6: anterior triangle
7: supraclav
Subclinical hyperthyroidism
normal T4, low TSH
5% progress - repeat tests in 8wks
tx if a fib, sx, goitre, osteoporosis
Subclinical hypothyroidism
high TSH, normal T4
tx if sx, pregnant, atherosclerosis, hyperlipidaemia
Graves' disease
anti-TSHR, anti-tg, anti-TPO
Graves' dermopathy: pretibial myxoedema
Thyroid investigations
US
malignant nodule features: solid, irregular margins, microcalcifications, vascular, >5cm, lymphadenopathy
scintigraphy
nuclear scan using technetium
hot nodule: unlikely to be ca
cold nodule: 10% cancerous
diffuse uptake: Graves'
patchy uptake: toxic multinodular goitre
single area of uptake: solitary nodule
Bx
usually US-guided FNAC as core bx risking
Thy grading
thy1: non diagnostic
thy2: benign
thy3: uncertain
3a: atypia
3f: follicular
thy4: suspicious
thy5: malignant
Thyrotoxicosis
hypermetabolic state due to elevated T4
Tx
propranolol
anticoag if a fib
carbimazole can be used in acute setting (initial high dose)
Thyroid ca
papillary
account for 80%
psammoma bodies + orphan annie nuclei
follicular
more aggressive variants: hurthle cell + insular
typically spreads haematogenously to bone + lungs
anaplastic
medullary
NET of parafollicular aka c cells
tumour marker = calcitonin - causes flushing + diarrhoea
can be a/w MEN2
mainstay of tx = thyroidectomy
lobectomy can be considered in small tumours
+/- radical or modified LN dissection
comps: strap haematoma, hypoparathyroidism, hoarseness due to N injury