1. Enlarged thyroid gland
Dr. M. Malek

2. Enlarged thyroid Diffusely enlarged (goiter)
Multinodular (Multinodular goiter)
Partially enlarged (single thyroid nodule)
جهت معاینه تیروئید از بیمار میخواهیم تا سر خود را به عقب خم کند.(باربارابتز) بیمار نشسته باشد و ما در حالت ایستاده از پشت گردن بیمار را معاینه کنیم.

3. لمس تیروئید
روشهای متعددی برای این معاینه وجود دارد اما بهتر است لمس از خلف انجام شود.
از پشت سر انگشتان هر دو دست خود را به گونه ای بر گردن بیمار بگذارید که انگشتان اشاره شما درست زیر کریکوئید قرار گیرد.

4. گردن بیمار باید راست باشد ولی نه آنقدر که عضلات را کشیده و سفت کند.
در صورت لزوم خم شدن گردن بیمار را تعدیل کنید.
زمانی که بیمار آب دهانش را قورت میدهد، ایسم تیروئید باید زیر انگشتان شما بالا بیاید.
با چرخاندن انگشتان خود به سمت پایین و طرفین، لوبهای طرفی به خصوص کناره های تحتانی آنرا لمس کنید.

7. Goiter refers to an enlarged thyroid gland
Biosynthetic defects
Iodine deficiency
Autoimmune disease
Nodular diseases
By different mechanisms

8. Biosynthesis effect & iodine deficiency→
Reduced efficiency of thyroid hormone synthesis
→Increase TSH
→Stimulation of thyroid growth
(compensatory mechanism)

9. Enlargement of the thyroid suggests nothing about the function of thyroid.
Because can be:
Hyper functioning
Normal functioning
Hypo functioning

10. Evaluation Is undertaken principally to determine the thyroid function
& presence or absence of malignancy.

12. Thyroiditis Fever, enlarged & tender thyroid Bacterial infection
TFTs are usually normal.

14. Grave, s (diffuse toxic goiter)
Is the most common cause of goiter & hyperthyroidism.
An autoimmune disease
Antibodies act to simulate thyroid function.
Exophthalmos, burning, itching, pretibial dermopathy.

15. Thyroid acropachy:Periosteal proliferation secondary to thyroid disease

17. Trophoblastic tumors Rarely can simulate goiter & hyperthyroidism.
HCG has some biologic cross-activity with TSH.

19. Jadbasedow phenomenon
Hyperthyroidism induced by iodine supplementation.

21. De quervain,s thyroiditis
Subacute granulomatous thyroiditis
Painful enlargement
Fever, malaise, chills
F/M: 3
Unknown cause but usually follows a viral infection by several weeks
Neutrophils, lymphocytes & giant cells (granolomata)

23. Subacute lymphocytic thyroiditis
A painless thyroiditis, hyperthyroidism & enlargement
Unknown cause probably autoimmune

25. Hashimoto Chronic lymohocytic thyroiditis
Most common thyroid disorders in USA
Painless palpable goiter
Usually initially euthyroid
But ultimately almost always hypothyroid
Hyperthyroidism: must be distinguished from Graves

26. Hashimoto Dx: Antimicrosomal Abs : In approximately 95%
Antithyroglobolin Abs : in 50% to 60%
Radioactive iodine uptake: may be normal, low or increased
Anti TPO antibodyهمان آنتی بادیهای آنتی میکروزومال هستند.

28. Reidel ,s thyroiditis A rare disorders A firm, enlarged gland
Sclerosing fibrous infiltration
Hypothyroidism

30. Endemic goiter In a large fraction of the population.
Most commonly a result of iodine deficiency.
Now is very rare in the USA owing to iodinization of salt.

32. Sporadic goiter An enzymatic defect.
Leading to low thyroid hormone levels.
Elevated level of TSH.

34. Pituarity adenoma May secret TSH autonomously.
Without sensitivity to negative feedback.

35. TFT
Thyroid function tests should be performed in all patients with goiter to exclude thyrotoxicosis or hypothyroidism.
Harrison

36. Thyroid scanning
Thyroid scanning is not generally necessary but will reveal increased uptake in iodine deficiency and most cases of dyshormonogenesis.
Harrison

37. Ultrasound
Ultrasound is not generally indicated in the evaluation of diffuse goiter unless
a nodule is palpable on physical examination.
Harrison