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THYROID ANATOMY AND PATHOLOGY
Muni Venkatesh.PGroup 2
ANATOMY
It is an endocrine gland.
Located in the anterior region of the neck at C5-T1, overlays 2nd – 4th tracheal rings.
Anterior & lateral to larynx and trachea. Average width: 12-15 mm (each lobe) Average height: 50-60 mm long Average weight: 25-30 g in adults.
It has two lobes, which are connected by isthumus.
1.25 cm x 1.25 cm
Crosses tracheal rings between 2 and 4
Occasionally absent
Pyramidal lobe may be present
PYRAMIDAL LOBE
Often ascends from the isthmus or the adjacent part of either lobe up to the hyoid bone
May be attached by afibrous/fibromuscular
band “levator” of the thyroid gland.
STRUCTURE Gland is covered by
capsule. Capsule extensions within
the gland form septae, dividing it into lobes and lobules.
Lobules contains follicles(structural units of the gland).
Follicles are surrounded by dense plexuses of fenestrated capillaries, lymphatic vessels, and sympathetic nerves.
Lobules are attached to cricoid cartilage by ligaments
Medial surface adapted to larynx and trachea
Lobes related posteriorly to the esophagus
Posterolateral surface
a. related to carotid sheath
b. overlaps carotid artery.
Epithelial cells = 2 types:
principal (ie: follicular) – formation of colloid (iodothyroglobulin)
parafollicular (ie: C cells -clear, light), lie adjacent to follicles w/in basal lamina produce calcitonin
MUSCULAR LANDMARKS
a. Sternocleidomast -oid muscles lie laterallyb. Longus collimuscles lie posteriorly c.Strap muscle, omohyoid muscle andsternohyoid muscles lie anteriorly
BLOOD SUPPLY
Highly vascular gland supplied by four large arteries
a. Right & Left inferior thyroid artery
b. Right & Left superior thyroid artery
Drained by Right & Left superior, middle and inferior thyroid veins
a. Veins arise from plexus
b. on anterior surface of gland
c. Extend over anterior surface of trachea
LYMPH VESSELS
1. In interlobular connective tissue between lobes.
2. Connect with network in wall of gland 3.Terminate in thoracic and right lymphatic ducts.
AUTONOMIC INNERVATION
a.Cervical portion of sympathetic trunkb.Parasympatheticfibers arise from Vagus X
DISEASES OF THE THYROID GLAND
Congenital diseases
Inflammation
Functional abnormality
Diffuse and Multinodular goiters
Neoplasia
INFLAMMATION
Thyroiditis
Acute illness with pain
Infectious
Acute
Chronic
Subacute or granulomatous (De Quervain’s)
Little inflammation with dysfunction
Subacute lymphocytic thyroiditis
Fibrous (Riedel) thyroiditis
Autoimmune
Hashimoto thyroiditis
HASHIMOTO THYROIDITIS
Most common cause of hypothyroidism
Autoimmune, non-Mendelian inheritance
45-65 years, F:M = 10-20:1
Painless symmetrical enlargement
Risk of developing
B-cell non-Hodgkin’s lymphoma
Other concomitant autoimmune diseases
Endocrine and non-endocrine
HASHIMOTO THYROIDITISPATHOGENESIS
Immune systems reacts against a variety of thyroid antigens
Progressive depletion of thyroid epithelial cells which are gradually replaced by mononuclear cells → fibrosis
Immune mechanisms may includes: CD8+ cytotoxic T cell-mediated cell death Cytokine-mediated cell death Binding of antithyroid antibodies → antibody
dependent cell-mediated cytotoxicity
Outcome: progressive depletion follicular cells with
replacement by mononuclear inflammation and
fibrosis
HASHIMOTO THYROIDITIS
Diffuse enlargement
Firm or rubbery
Pale, yellow-tan, firm & somewhat nodular cut surface
HASHIMOTO THYROIDITIS
Massive lymphoplasmcyticinfiltration with lymphoid follicles formation
Destruction of thyroid follicles
Remaining follicles are small and many are lined by Hurthle cells
Increased interstitial connective tissue
FUNCTIONAL ABNORMALITY
Hyperfunction
in level of hormone → toxic effects
Due to:
Diffuse hyperplasia
Hyperfunctioning multinodular goiter
Hyperfunctioning adenoma
Subacute lymphocytic (painless) thyroiditis
FUNCTIONAL ABNORMALITY
Hypofunction in level of hormone → impair development in infants
and slowing of physical and mental ability in adults
Due to:
Postablation
Surgery
Radiation
Autoimmune thyroiditis
Drugs
Dyshormonogenetic
SYMPTOMS
Myxedematous psychosis, weight gain, depression, mania, sensitivity to heat and cold, paresthesia, chronic fatigue, panic attacks, bradycardia, tachycardia, high cholesterol,reactive hypoglycemia, constipation, migraines, muscle weakness, joint stiffness, menorrhagia, cramps, memory loss, vision problems, infertility and hair loss.
LABORATORY
Serum TSH level.
Free serum T3 and T4.
Detection of anti-thyroid peroxidaseautoantibody.
Detection of TSH receptor-blocking antibody.
By ultrasound.
TREATMENT The normal thyroid
hormone level is maintained by giving thyroxine therapy which will also help to reduce side of thyroid gland.
Complications of Hashimoto’s thyroiditisare changes in menstrual cycle, increse risk of abortions etc.