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Thyroid PowerPoint Presentation

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Description : thyroid part a presenrtation

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Published on : Jan 26, 2018 | Views : 2180 | Downloads : 14

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Slide 1-

A presentation on thyroid- part A
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GOOD MORNING This is Jwanesh, second year DNB post graduate of General surgery department 2
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"To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not going to the sea at all" Sir William Osler 3
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Embryology Here you have a list of items And some text But remember not to overload your slides with content Your audience will listen to you or read the content, but won’t do both. 4
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THYROGLOSSAL CYST AND SINUS LINGUAL THYROID ECTOPIC THYROID PYRAMIDAL LOBE Developmental anomalies 5
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Anatomy 6
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BLOOD SUPPLY ARTERIAL SUPPLY 1.SUPERIOR THYROID.A 2.INFERIOR THYROID.A 3.THYROIDAEA IMA.A 4.ACCESORY THYROID.A Place your screenshot here 7
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Nerves in relation to the gland 8
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9 LYMPHATIC DRIANAGE LYMPHATIC DRAINAGE Pre laryngeal node Para tracheal / pre tracheal nodes Peri thyroidal nodes Mediastinal nodes
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Place your screenshot here 10 THYROID PHYSIOLOGY IODINE METABOLISM THYROID HORMONE SYNTHESIS – SECRETION -TRANSPORT THYROID HORMONE FUNCTION
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Physiology contd… Synthesis Iodine trapping Oxidation and iodination Coupling Hydrolysis De iodination Secretion Controlled by hypothalamic-pituitary-thyroid axis Negative feedback loop Transport In serum, bound to carrier proteins ( T4 binding globulin, T4 binding pre albumin, albumin) T3 is more active than T4 The hormone enters cell membrane by diffusion/ carrier proteins and carried to nuclear membrane by binding to specific proteins 11
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Thyroid hormone function The hormone binds with high affinity to nuclear thyroid hormone receptors Confirmational changes in receptors eventually leads to gene expression FUNCTIONS 1.Fetal brain development 2.Oxygen consumption, BMR 3.Positive ionotropic and chronotropic effects 4.Amplifies catecholamine actions 5.Maintains normal hypoxemic and hypercapnic drives 6.GI- Motility 7.Increase glycogenoysis, gluconeo genesis 12
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EVALUATION OF PATIENTS 13
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THYROID IMAGING 15
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Benign thyroid disorders 16
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Hyperthyroidism Clinical manifestations of hyperthyroidism results from an excess of circulating thyroid hormone
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Grave's disease ETIPOATHOGENESIS Possible triggers – post partum state, iodine excess, infections Genetic – HLA B8, DR3 Thyroid stimulating antibodies, stimulate the thyrocytes 19
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20 Management
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Hyperthyroidism contd… Toxic multi nodular goitre Older individuals, with prior history of non toxic MNG Thyroid nodules become autonomous Precipitants- iodine containing drugs, amiodarone Treatment- Control hyperthyroidism, plan for total or near total thyroidectomy RAI therapy is resrved for elderly patients, who present very poor operative risks, provided there is no air way compression Toxic adenoma Typically occurs in younger patients Single nodule hyperfunctions associated with symptoms of hyperthyroidism Charectarised by somatic mutations in TSH-R gene Physical examination reveals - solitary thyroid nodule RAI scanning shows hot nodules Smaller nodules can be managed with RAI and anti thyroid medications Surgery is indicated in the young and those with larger nodules 21
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GRAVE'S DISEASE MULTINODULAR GOITRE ADENOMA 22
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THYROID STORM
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Hypothyroidism-causes Primary (increased TSH ) Hashimoto's thyroiditis RAI therapy Post thyroidectomy Excessive iodine intake lithium Secondary (decreased TSH) Pituitary tumor Pituitary resection or ablation Tertiary Hypothalamic insufficiency Resistance to thyroid hormone 24
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Thyroiditis 26
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Acute thyroiditis ETIO PATHO GENESIS More common in children Streptococcus and anaerobes account for 70% of cases Infection can seed thyroid via Hematogenous route Direct spread Trauma immunosuppression Suspect persistent pyriform sinus fistula in children with recurrent acute thyroiditis CLINICAL FEATURES Severe neck pain, fever, odynophagia, dysphonia Complications - sepsis, tracheal or esophageal rupture MANAGEMENT Diagnosis Leukocytosis, FNAB, CT scan Direct endoscopy - has 100% sensitivity for identifying pyriform sinus fistula in acute setting Treatment Parenteral antibiotics Drianage of abscess Complete excision of sinus track Trans-nasal flexible fiberoptic laryngoscopy – electro cauterisation 27
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Sub acute thyroiditis 28
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Chronic thyroiditis Hashimoto's Thyroiditis Etio pathogenesis Auto immune process- CD4-Th cells activation Hypothyroidism due to destruction of thyrocytes, auto antibodies blockade of TSH-Receptors Antigens are- thyroglobulin, TPO,TSH-R Associations- HLA B8, DR3, DR 5, turners and downs syndrome Pathology Diffuse lymphocytic infiltration Hurthle/askanazy cells 29
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Clinical presentation-minimally or moderately enlarged firm gland discovered on routine examination- more common in woman of age group 30-50 - may evolve into lymhoma Diagnostic studies -Elevated TSH -presence of auto antibodies -FNAB with USG guidance Treatment Thyroid hormone replacement For subclinical hypothyroidism- levothyroxine, if TSH levels 10 microIU/ml Surgery 30
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Reidels thyroiditis Etiology Autoimmune Associations- focal sclerosing syndromes Occurs in women of ages 30-60 Clinical features Painless hard neck mass progresssing over weeks to years Symptoms of compression Hypothyroidism, hypoparathyroidism Hard woody thyroid gland with fixity Management diagnosis is confirmed by open thyroid biopsy Surgery - wedge excision of vthyroid isthmus Hormone replacement, micophenolate mophetil,steroids 31
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Thank you 32