2. DEVELOPMENT OF THE THYROID GLAND
•Develops from thyroglossal duct which
give rise to follicular cells of the
thyroid gland.
•Neural crest cells of
the ultimobranchial body migrate into
the gland and give rise to
the parafollicular cells (aka C-cells) of
the thyroid.
Terminal
sulcus of the
tongue.
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3. SURGICAL ANATOMY
3
• Weighs 20–25 g.
• Lies against C5 - T1 vertebra
• Each lobe is 5 x 3 x 1.5 cm - extends from middle of thyroid cartilage
to 6th tracheal ring
• Isthmus – midline connecting part – extend from 2nd to 4th tracheal
ring
• Gland is invested by pretracheal fascia
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6. Two Content Layout with Table
• First bullet point here
• Second bullet point here
• Third bullet point here
Group A Group B
Class 1 82 95
Class 2 76 88
Class 3 84 90
6
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11. THYROTOXICOSIS
11
HYPERTHYROIDISM
A Symptom complex due to raised levels of thyroid hormones
It refers to the biochemical & physiological manifestations of excessive
thyroid hormones
It can also occur due to causes other than hyperthyroidism.
The term used for excessive production of hormones by the thyroid
gland
Pathology is in the thyroid gland itself
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20. CLINICAL TYPES
20
• DIFFUSE TOXIC GOITRE (GRAVES’
DISEASE)
• TOXIC NODULAR GOITRE
• TOXIC NODULE
• HYPERTHYROIDISM DUE TO RARER
CAUSES
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21. DIFFUSE TOXIC GOITRE (GRAVES’ DISEASE,
Parry’s or Basedow’s disease)
21
The most common cause of thyrotoxicosis (50-60%).
Strong familial predisposition, female preponderance (5:1), and peak
incidence between the ages of 40 to 60 years
Graves’ disease is an Organ specific auto-immune disorder with
three major manifestations:
1) Hyperthyroidism with diffuse goiter
2) Ophthalmopathy and
3) Dermtopathy.
Graves' disease also is associated with other autoimmune
conditions such as type I diabetes mellitus, Addison's disease,
pernicious anemia, vitiligo and myasthenia gravis
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22. Thyroid Stimulating Immunoglobulin (TSI) or
TSA
acts as proxy to TSH and stimulates T4 and T3
22
LATS Ab
Thyroid stimulating Ig
Thyroid growth stimulating Ig
Anti-TSH receptor Ig
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23. TOXIC MULTINODULAR GOITER
23
20 %
A simple nodular goitre is present for a long time
hyperthyroidism, usually in the middle-aged or elderly.
The syndrome is that of secondary thyrotoxicosis.
Frequently presenting with cardiac manifestations &
infrequently is associated with eye signs
Either the internodular thyroid tissue or one or more nodules
are overactive
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24. 5 %
TSA is a single hyper functioning follicular thyroid adenoma
Benign monoclonal tumor that usually is larger than 2.5 cm
Not due to TSH-RAb.
24
TOXIC NODULE
25. 25
THYROTOXICOSIS FACTITIA
JOD–BASEDOW THYROTOXICOSIS - Large doses of iodide given to
a patient with a hyperplastic endemic goiter that is iodine avid may
produce temporary hyperthyroidism and, very occasionally, persistent
hyperthyroidism.
SUB ACUTE /ACUTE FORMS OF AUTOIMMUNE THYROIDITIS
OR DE QUERVAIN’S THYROIDITIS
SECONDARY CARCINOMA
STRUMA OVARII
POST-PARTUM HYPERTHYROIDISM
NEONATAL THYROTOXICOSIS
HYPERTHYROIDISM DUE TO OTHER
CAUSES
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27. 27
RADIOISOTOPE STUDY BY I-131 , 99m technetium
ECG TO DEMONSTRATE CARDIAC MANIFESTATIONS
TOTAL COUNT & NEUTROPHIL COUNT
THYROID ANTIBODIES ESTIMATION (anti-Thyroglobulin
Ab , TSH receptor Ab , anti – TPO Ab ) LAKSHMI S
29. 29
1. Symptom relief medications
2. Anti Thyroid Drugs – ATD
Methimazole (20-40 mg OD) , Carbimazole ( 5-10
mg QID )
Propylthiouracil (PTU, 100 to 300 mg TID )
3. Radio Active Iodine treatment – RAI Rx.
4. Thyroidectomy – Subtotal or Total
5. NSAIDs and Corticosteroids – for SAT
TREATMENT
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30. 30
DTG – An initial course of antithyroid drugs with
radioiodine for relapse
TNG - Treated Surgically
TOXIC NODULE - Surgery or radioiodine treatment is
appropriate
FAILURE OF PREVIOUS TREATMENT WITH
ANTITHYROID DRUGS OR RADIOIODINE –
Surgery or thyroid ablation with I-123 is appropriate
TREATMENT OF CHOICE
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31. THYROTOXIC CRISIS (STORM)
31
An acute exacerbation of hyperthyroidism occurs if a thyrotoxic patient has been
inadequately prepared for thyroidectomy and is now extremely rare
Symptomatic and supportive treatment is for dehydration,
hyperpyrexia and restlessness.
Intravenous fluids, cooling the patient with ice packs, administration of oxygen,
diuretics for cardiac failure, digoxin for uncontrolled atrial fibrillation, sedation
and intravenous hydrocortisone.
Specific treatment is by carbimazole 10–20 mg 6-hourly,
Lugol’s iodine 10 drops 8-hourly by mouth or sodium iodide 1 g i.v.
Propranolol intravenously (1–2 mg) or orally (40 mg 6-hourly) will block -
adrenergic effects
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32. HYPOTHYROIDISM
32
Deficiency in circulating levels of thyroid hormone
leads to hypothyroidism
Neonatal screening reveals incidence that varies
between 1-5/1000 live births
The most common cause of preventable mental
retardation ( CRETINISM) in children
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39. 2. ANTIBODY ESTIMATION
39
Thyroid autoantibodies ( TPO ANTIBODIES & anti-THYROGLOBULIN)
are highest in patients with autoimmune disease (Hashimoto's
thyroiditis) & may also be elevated in patients with nodular goiter and
thyroid neoplasms.
3. IMAGING
• CHEST X-RAY
• USG
• CT & MRI
4 . FNAC
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40. 40
1. T4 is the treatment of choice and is administered in
dosages varying from 50 to 200 mcg per day, depending
upon the patient's size and condition
2. Elderly patients and those with coexisting heart disease
- started lower dose such as 25 to 50 mcg daily because
of associated hypercholesterolemia and atherosclerosis
3. Dose is 10 mcg/kg/day in infancy. In older children start
with 25 mcg/day and increase by 25 mcg every 2 weeks
till required dose.
4. Regular follow-ups needed
TREATMENT
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42. MYXOEDEMA
42
The signs and symptoms of hypothyroidism are accentuated.
The facial appearance is typical, and there is often
supraclavicular puffiness, a malar flush and a yellow tinge to
the skin
Myxoedema coma, characterized by altered mental state,
hypothermia and a precipitating medical condition, for
example cardiac failure or infection, carries a high mortality.
bolus of 0.50 mg of T4 or 10 μg of T3 either i.v. or orally every
4–6 hours
Temperature is less than 30°C, the patient must be warmed
slowly.
Intravenous broad-spectrum antibiotics and hydrocortisone LAKSHMI S
43. Bailey & Love’s SHORT PRACTICE OF SURGERY
Schwartz's Principles of Surgery, Ninth Edition
S.DAS – CLINICAL SURGERY MANUAL
GOOGLE IMAGES
43
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