Goitre final year mbbs lecture

" Final Year MB BS " Lecture by Mr. Adeel Abbas

1. Mr. Adeel Abbas

3. Simon’s Triangle..???

5. What Does Your Thyroid
Gland Do for You?

6. Produces Two Hormones Called
•Thyroxine (T4)
•Thyronine (T3)
•Regulates Metabolism so Your Cells Function
Properly
Affects Every Cell in the Body

7. Goitre
Enlargement Of The Thyroid Gland (Local Or Diffuse)
Based On Hyperplasia Or Degeneration.

8. Classification
Diffuse Goitre.
Multi-Nodular Goitre.
Solitary Thyroid Nodule.

9. Diffuse Goitre
More Commonly Non-Toxic.
May be Toxic.

10. Diffuse Non-Toxic Goitre
Compensatory Hypertrophy & Hyperplasia due to
Decrease in T3 & T4.
Diffusely Involves Whole Gland.
Not Associated With
Hypo OR Hyperthyroidism.

11. Causes
Physiological Goitre:
Puberty OR Pregnancy.
Dietary Iodine Deficiency:
In Areas Far From Sea.
Dietary Goitrous Agents:
Cabbage & Turnips.
Calcium or Flouride in water.
PAS, Lithium, Phenylbutazone, Thiouracil, Carbimazol.

12. Causes cont:
Hereditary.
Treated Graves’ Disease.
Rare Cause:
Lymphoma.
Anaplastic.
Thyroiditis (Autoimmune or de-Quervain’s).
Amyloidosis.

13. Treatment
Small:
No Treatment.
Reassurance.
Iodine Support.
Large/Pressure Symptoms OR Cosmesis:
Near-Total Thyroidectomy.

14. Fate (of Diffuse Non-Toxic Goitre)
Revert to Normal.
Stays the Same.
Progress to Multi-Nodular Goitre.

15. Multi-Nodular Goitre
Progression from Diffuse Simple Goitre.
Upto 2 kg.
Multinodular Focal Hyperplasia.
Mostly Euthyroid.

16. Causes
Progressive Enlargement of Diffuse Goitre.
Sporadic.
Previous Irradiation to Neck.

17. Pathological Features
Colloid Abundant.
Follicular cells have round to oval nuclei.
Follicle cell cytoplasm is scant.
Inflammation.
Infarction.
Haemorrhage.
Fibrosis.
Calcification.
Cyst Formation.

18. Clinical Presentation
Cosmetic.
Discomfort..
Irritating Cough.
Dysphagia.
Wish to Exclude Malignancy.
Hyperthyroidism.
Hoarseness.

19. Complications
Local Symptoms:
Stridor / Dysphagia / Retrosternal Enlargement /
Cosmesis.
Toxicity.
Malignant Change (5%).
Haemorrhage into Cyst.

20. Treatment
Medical:
Thyroxine.
Surgery:
Total Thyroidectomy.
Near-Total Thyroidectomy.

21. Solitary Thyroid Nodule
5% of Adult Population.
50% Large Nodule in MNG.
50% True Solitary.
80% are Adenomas.
10% Carcinomas.
10% Cyst / Fibrosis / Thyroiditis.

22. Management
Full Clinical Assessment including;
TFT.
Ultrasound.
FNAC.

23. Treatment
Colloid Cyst:
Repeat FNAC & Reassurance.
Simple Cyst:
<4cmm  Reassurance.
>4cm  Lobectomy.
Follicular Cells:
Lobectomy  Completion Thyroidectomy.
Papillary Carcinoma:
Total Thyroidectomy.

24. Investigating Thyroid
Most Sensible & Universal Investigations;
Ultrasound.
FNAC.

25. Antibodies.
Serum Cholesterol.
CXR.
Iodine Isotope Scan.
IDL.
Bronchoscopy.

28. Key Points
Toxic Goitre are Rarely Malignant.
All Solitary Goitre Need to Exclude Malignancy.
Surgery is Rarely Needed in Autoimmune or
Inflammatory Thyroid Disease.