Goitre final year mbbs lecture

Mr. Adeel Abbas

Simon’s Triangle..???

What Does Your Thyroid Gland Do for You?

Produces Two Hormones Called

•Thyroxine (T4)•Thyronine (T3)

• Regulates Metabolism so Your Cells Function Properly

Affects Every Cell in the Body

Goitre

Enlargement Of The Thyroid Gland (Local Or Diffuse)

Based On Hyperplasia Or Degeneration.

ClassificationDiffuse Goitre.

Multi-Nodular Goitre.

Solitary Thyroid Nodule.

Diffuse GoitreMore Commonly Non-Toxic.

May be Toxic.

Diffuse Non-Toxic GoitreCompensatory Hypertrophy & Hyperplasia

due to Decrease in T3 & T4.

Diffusely Involves Whole Gland.

Not Associated With Hypo OR Hyperthyroidism.

CausesPhysiological 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.

Causes cont:

Hereditary.

Treated Graves’ Disease.

Rare Cause:Lymphoma.Anaplastic.Thyroiditis (Autoimmune or de-Quervain’s).Amyloidosis.

TreatmentSmall:

No Treatment.Reassurance.Iodine Support.

Large/Pressure Symptoms OR Cosmesis:Near-Total Thyroidectomy.

Fate (of Diffuse Non-Toxic Goitre)Revert to Normal.

Stays the Same.

Progress to Multi-Nodular Goitre.

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

CausesProgressive Enlargement of Diffuse Goitre.

Sporadic.

Previous Irradiation to Neck.

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

Clinical PresentationCosmetic.Discomfort..Irritating Cough.Dysphagia.Wish to Exclude Malignancy.Hyperthyroidism.Hoarseness.

ComplicationsLocal Symptoms:

Stridor / Dysphagia / Retrosternal Enlargement

/ Cosmesis.

Toxicity.

Malignant Change (5%).

Haemorrhage into Cyst.

TreatmentMedical:

Thyroxine.

Surgery:

Total Thyroidectomy.

Near-Total Thyroidectomy.

Solitary Thyroid Nodule5% of Adult Population.

50% Large Nodule in MNG.50% True Solitary.

80% are Adenomas.10% Carcinomas.10% Cyst / Fibrosis / Thyroiditis.

ManagementFull Clinical Assessment including;

TFT.

Ultrasound.

FNAC.

TreatmentColloid Cyst:

Repeat FNAC & Reassurance.Simple Cyst:

<4cmm Reassurance.>4cm Lobectomy.

Follicular Cells:Lobectomy Completion Thyroidectomy.

Papillary Carcinoma:Total Thyroidectomy.

Investigating ThyroidMost Sensible & Universal Investigations;

Ultrasound.

FNAC.

Antibodies.

Serum Cholesterol.

CXR.

Iodine Isotope Scan.

IDL.

Bronchoscopy.

Key PointsToxic Goitre are Rarely Malignant.

All Solitary Goitre Need to Exclude

Malignancy.

Surgery is Rarely Needed in Autoimmune or

Inflammatory Thyroid Disease.