1. Thyroid Disease
M. Alhashash MD

2. Anatomy Over Trachea Two Lobes connected together by an isthmus

3. Sites of normal & ectopic thyroid tissue

4. FUNCTIONAL UNIT IS THE FOLLICLE

5. Arterial supply Superior thyroid artery Inferior thyroid artery
Thyroida ima artery
Anastomosis with esophagus and trachea

6. Venous drainage Superior thyroid vein IJV Middle thyroid vein IJV
Inferior thyroid vein innom. V.

7. Lymphatics Direct : Upper and lower deep cervical LN Indirect :
Pretracheal LN
Paratracheal LN
Inferior and superior thyroid veins LN

8. Nerve supply
Sympathetic (blood supply)
Parasympathetic (RLN)

9. Thyroid Regulation

10. Normal Physiology TSH stimulates secretion of T4 and T3 from thyroid
Most serum T3 produced by deiodination of T4
Think of T3 as active hormone and T4 as prohormone
Only small fraction total T4 and total T3 is unbound – therefore free and active

11. TFTs
TSH is the screening test of choice for thyroid function (nml 0.3-5mU/L) T4 T3
Antithyroglobulin (TSAb)

12. Evaluation of Thyroid Diseases
Clinical history and physical examination
Serum T3 & T4, TSH determination
Thyroid scan (RAIU)
Thyroid ultrasound
Plain x-ray, CT scan / MRI
FNAC
Sleeping pulse & laryngoscope.

13. THYROID GLAND DISORDERS
CONGENITAL
SIMPLE
Diffuse : 1-physiological colloid
Nodular 1-multinodular solitary
Toxic
Primary
Secondary
Neoplastic
Benign
Malignant.
Inflammatory

14. Answer the following questions: (time allowed 5 minutes)
Enumerate types of shock:
Define:
Epistaxis: is………………………………………..
Hemoptesis: is…………………………………...
Good luck.

15. Congenital anomalies 1 Agenesis------------ L-troxine
Ectopic (along the line of descent)
Lingual at the foramen caecum , may be the only thyroid tissue, causes yellow swelling, dysphagia and bleeding . Treatment : L-troxine , excision and reimblantation.
Median ectopic in the upper 2/3 of neck , can be the only thyroid tissue . Treatment excision and reimplantation.
Aberrant(away from the line of descent)
Median (larynx, trachea, intrathoracic)
Lateral(obsolete term, in LNs= metastasis)

16. Sites of normal & ectopic thyroid tissue

17. Congenital anomalies 2 Anomalies of thyroglosal tract
Thyroglossal cyst
Thyroglossal fistula(sinus)

18. Simple goiter
Def : non inflammatory , non toxic, non neoplastic enlargement of thyroid gland.
Etiology : ch. Decrease of thyroid hormone or rarely pituitary adenoma.
Decrease I2
Decrease synthesis of hormones
Antithyroid drugs
Goitrogenic substances (cabbage, cauliflower)

19. Stress leads to dec. T3 & T4increase TSH physiological goiter.
Stress over --> normal gland
Prolonged stress exhaustion of the gland diffuse colloid goiter and after time nodular colloid goiter.
Stress repeated fibrosis simple multinodular goiter.

20. Treatment of simple goitre.
Physiological L-troxine + I2 -> good response.
Colloid rarely respond
Nodular goiter never respond to medical treatment.
Subtotal or total thyroidectomy followed by L-troxine.

21. Complication of simple goiter.
Haemorrhage
Secondary thyrotoxicosis
Malignant transformation(size, pain, ill defined, fixed, hard, LNs, vessel & nerves)
Calcification
Cyst formation
Retrosternal extension
Infection
Pressure (trachea, carotid v. , retrosternal)