Goitre
Simple
Investigations
Types
Complications (nodular)
Stages
Aetiology
Clinical (nodular)
Iodine defeciency
Enzymatic deficiency
Goitrogens
Simple colloid
Simple nodular
Simple physioloical
Tracheal obstruction
2ry thyrotoxicosis
Malignancy
Cust formation
Heamorrhage
Calcification
Retrosternal extension
Cosmotic dis.
Some resp. obstruction
Firm thyroid with nodular surface
Sudden enlargment >> heamorrhage
Hardness if calcification
Euthyroid pt.
Kocher test
Thyroid function test
Thyroid Abs
Neck US
FNAC if suspecious
TTT
Prevention
Iodized tablet salt in endemic areas
Physiologic goitre
- No ttt
- Reassurence
- Regular follow up
If pressure symp. >>> L-thyroxine 0.1-0.2mg/day
MNG
thyroidectomy if
compression symptoms
Cosmotic disfigurment
Postop. replacement of L- thyroxine
Toxic
Diagnosis
Investigations
Clinical (9)
Treatment
Pathology
Special problems
Common types
Toxic (2ry) toxic g. (Plummer's dis.) 19%
Diffuse (1ry) toxix g. (Graves' dis.) 76%
Toxic nodule 5%
2ry
1ry
Toxic nodule
due to Thyroid stimulating Abs
Whole gland enlargment
Proliferation of acini epithelial lining
Columnar cells. full of granules
Marked vascularity increase
Extensive lymphocytic infiltration
Nervous, metabolic and eye manifestations
Affect mainly young females
Charactarized bu remession and exxacerbations
On top of long standing simple modular goiter
Affected middle aged and elderly persons
Hyperactive internodular tissue
Insidious onset with more cardiovascular manifestations
Solitary, hyperactive and autonomous
Cause TSH secretion suppression with subsequent suppression of the remainder of thyroid
Matabolic(4)
Nervous (3+3)
Cv (3+3)
Muscular (2)
Skin (2)
GI (1)
Endocrine (1+3)
Urinary (2)
Eyes
True exophthalmos
False exophthalmos
Eye signs
Autoimmune manifestation
Die to retrobulber cells and fliud infeltration
Papilleoedema, corneal ulceration and optic nerve neuropathy in severe cases
Lateral tarsorrhaphy help to protect eye
Improvement with high dose of systemic prednisolone
Clinical detection of exophthalmos
Nafziger's method
Russel Frazer's method
Ruler test
Due to upper eyelids retraction
In both diffuse and nodular toxic goiter
Disappears when hyperthyroidism is treated
Moderate
Severe
Mild
Stellwell's sign
Von Graefe's sign
Dalrymple's sign
Joffroy's sign
Moebius's sign
Local signs
Diffuse
Diffusely enlarged gland
click to edit
Graves disease versus toxic modular goiter table
Hot nodule on isotope scanning I123
Neck US
Thyroid function test
Medical treatment
Radioactive iodine
Syrgery
Aim
Medications
Indications (5)
Advantages
(avoid surgery & radioactive iodine SE)
Drawbacks (4)
Euthyroid then maintenance dose
Antithyroid drugs
B blocker
Carbimazole
Propylthiouracil (Pregnant & lactating)
Iodides
Mexhanism of action
Dose
Possible side effects
(not proven)
Diffuse (1ry) or nodules (2ry) goitre
Duration
Mantainence
Dose
Side effects
Action
Action
Chemical jacket of the heart
Action
Contraindication
Action
Wolf- chaik off effect
Duration
Indication
Destroys thyroid cells >>> decrease functioning thyroid tissue
Leukemia
Thyroid carcinoma
Genitic damage
Indications (5)
Advantages
Disadvantages
Thyroid insufficiency in 75-80%
Avoidance of surgery and prolonged medical ttt
Preparation
Advantages (2)
Indications (6)
Drawbacks (3)
Pregnancy
Children
Thyrocardiac
Recent proptosis