Multinodular non-toxic goiter thyroid malignancy Medical Presentation

Thyroid Case PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Download Free Thyroid Case medical powerpoint (ppt) presentation for your medical ppt presentation

Tags : thyroid

Published on : Sep 26, 2017 | Views : 2450 | Downloads : 15

Shareable Url :

Embed Code :

Comment

lolliwels

looks amazing on my PPT - thank you

Transcript

Slide 1-

Good Day!! Raymond De Gula Clinical Clerk
Slide 2-

General Data C.E. 52/F Single
Slide 3-

Anterior Neck Mass 52/F Chief Complaint
Slide 4-

History of Present Illness 52/F
Slide 5-

52/F 9 months PTA Enlarging neck mass Palpitations Dizziness Difficulty of breathing Easy fatiguability Prompted consult AP NST (normal) Isthmus biopsy (benign features) UTZ enlarged thyroid lobe Left with solid nodules Prescribed Levothyroxine 100mg OD provided minimal relief of symptoms HISTORY OF PRESENT ILLNESS
Slide 6-

52/F 5 months PTA Neck mass persisted now with associated pain with the former symptoms RPT UTZ : minimal increase in size of neck mass. Hence consultation and subsequent admission HISTORY OF PRESENT ILLNESS
Slide 7-

52/F (+) HPN 4-5 years Losartan + Hydrochlorothiazide 150mg + 12.5mg/OD (-) Heart Disease (-) Asthma (-) Tuberculosis (-) Convulsion (-) Allergy (-) exposure to radiation (+) surgery Thyroid Lobectomy Right (1994) On Levothyroxine treatment Past Medical History
Slide 8-

52/F (+) HPN- BOTH (+) DM – BOTH (+) Heart Disease - BOTH (-) Bronchial Asthma (+) Cancer (lungs, breast, cervix, endometrial, colon) Paternal and maternal (+) Thyroid problem – mother, siblings Family History
Slide 9-

52/F (-) smoker (-) alcoholic beverage drinker Diet: fish, meat, vegetables Personal and Social History
Slide 10-

52/F PHYSICAL EXAMINATION
Slide 11-

52/F PHYSICAL EXAMINATION General Survey: Awake, conscious, coherent, not in cardiorespiratory distress Vital Signs: BP:120/80mmHg PR: 88 RR: 19 Temp: 36 Weight: 62kgs
Slide 12-

52/F PHYSICAL EXAMINATION Skin: brown, warm, moist, elastic, with good skin turgor HEAD: Normocephalic, no mass, no lesions EYES: pinkish palpebral conjuctiva, anicteric sclerae, pupils equally round and reactive to light and accommodation EAR: No aural discharge
Slide 13-

52/F PHYSICAL EXAMINATION Nose: Patent nasal passages, midline septum, frontal and maxillary sinuses non-tender Throat: No tonsillopharyngeal congestion; no cervical lymphadenopathy, midline trachea, (+)palpable ovoid mass – 6cm x 4cm on left anterior neck area, firm, movable, with palpable nodules, non tender, does move with deglutition Chest and Lungs: Symmetric chest expansion, no intercostal retractions, clear and equal breath sounds
Slide 14-

52/F PHYSICAL EXAMINATION Heart: Adynamic precordium, normal rate, regular rhythm, no murmur Abdomen: Flabby, non tender, normoactive bowel sounds on all quadrants, tympanitic on all quadrants
Slide 15-

52/F PHYSICAL EXAMINATION Genitourinary: Non-distended bladder Extremities: Full, equal pulses on both extremities, no edema Neurologic: No focal neurologic deficits Rectal Examination: Not assessed
Slide 16-

Multinodular non-toxic goiter R/O thyroid malignancy Admitting Impression: 52/F
Slide 17-

52/F Course in the Ward Diagnostic Workups
Slide 18-

52 / F X-RAY (CHEST PA or AP) 09/07/2017 Both lung fields are clear Heart is not enlarged Diaphragm and sinuses are intact
Slide 19-

52 / F ELECTROCARDIOGRAPHIC REPORT 9/07/2017 Normal Sinus rhythm
Slide 20-

52/ F
Slide 21-

52 / F
Slide 22-

9/04/2017
Slide 23-

Ultrasound of Thyroid Gland with Color Flow 7/26/2017 S/P Right Thyroidectomy Enlarged Multinodular Left Thyroid Lobe No significant change in sizes of mass/nodules (+) intranodular vascularity in the largest mass (With calcifications)
Slide 24-

DIFFERENTIAL DIAGNOSIS
Slide 25-

Papillary Thyroid Carcinoma Most common form Most patients are euthyroid Due to exposure to radiation Slow growing painless mass on the neck Women:men 2:1 FNAB: Orphan Annie Nuclei, Psammoma Bodies Invasive, possible metastasis
Slide 26-

Follicular Carcinoma Solitary thyroid nodules Differentiated from a thyroid follicular lesion because of capsular and vascular invasion No cervical lymphadenopathy
Slide 27-

Medullary Thyroid Carcinoma Originates in the parafollicular C cells which produces calcitonin Unilateral but is multicentric in familial types Tumors also secrete CEA Familial MTC has the worst prognosis
Slide 28-

Multinodular Non Toxic Goiter May be a result of iodine deficiency or TSH stimulation secondary to inadequate thyroid hormone synthesis Euthyroid state Goitrogens: cassava and cabbages Some are familial causes asymptomatic
Slide 29-

Admission
Slide 30-

Operation Done: Completion Thyroidectomy
Slide 31-

ppt slide no 31 content not found
Slide 32-

ppt slide no 32 content not found
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

ppt slide no 35 content not found
Slide 36-

1st Hospital Day
Slide 37-

2nd Hospital Day
Slide 38-

DISCUSSION 52 / F
Slide 39-

EMBRYOLOGY Arises as an outpouching of the primitive foregut around the 3rd week AOG originating at the base of the tongue in the vicinity of the foramen cecum Endoderm cells – thyroid follicular cells Neuroectoderm cells of paired lateral anlages – parafollicular C cells
Slide 40-

ANATOMY About 20g Posterior to the strap muscles Connected in the midline by isthmus Blood supply – superior thyroid arteries and inferior thyroid arteries Venous Drainage – superior, middle and inferior thyroid veins
Slide 41-

ppt slide no 41 content not found
Slide 42-

ppt slide no 42 content not found
Slide 43-

ppt slide no 43 content not found
Slide 44-

The thyroid gland is endowed with an extensive network of lymphatics: Pretracheal Paratracheal Perithyroidal Superior mediastinal Retropharyngeal Esophageal Upper, middle and lower jugular chain nodes
Slide 45-

ppt slide no 45 content not found
Slide 46-

Thyroid Physiology Iodine converted to iodide Thyroid hormone synthesis entails the following: Iodide trapping via NIS symporter Oxidation of iodide to iodine and iodination of tyrosine residues on Thyroglobulin Coupling of DIT and MIT molecules forming T3 and T4 Hydrolysis of Tg to release free iodothyronines Deiodination of MIT and DIT to be reused 52/ F
Slide 47-

ppt slide no 47 content not found
Slide 48-

52/ F FINAL DIAGNOSIS: MULTINODULAR NON TOXIC GOITER S/P Completion Thyroidectomy
Slide 49-

Signs and Symptoms Neck mass Dysphagia and dyspnea (+) Pemberton Sign Acute pain Nodules of various sizes and consistency upon palpation May have tracheal Deviation with or without compression
Slide 50-

52/ F DIAGNOSTICS Thyroid Function test FNAB for dominant enlarging or painful nodule
Slide 51-

MANAGEMENT: If asymptomatic: none Surgical resection is indicated for: Continued increase despite T4 suppression Causing obstructive symptoms Substernal extension Suspected to be malignant Cosmetically unacceptable Treatment of choice: Total lobectomy on the side of dominant nodule and subtotal resection on the contralateral side Requires lifelong T4 therapy to prevent recurrence
Slide 52-

ppt slide no 52 content not found
Slide 53-

THANK YOU !