Fwd: Thyroid Surgery (Cormac Joyce)
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Transcript of Fwd: Thyroid Surgery (Cormac Joyce)
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Thyroid
Cormac Joyce
November 21st 2008
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Thyroid
Causes of solitary thyroid nodule:o Prominent nodule in MNGo Cysto Follicular adenomao Carcinomao Thyroiditis
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Thyroiditis
Inflammation of thyroid glandCauseso Hashimotoso De Quervains
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Hashimotos
Chronic Lymphocytic ThyroiditisThyroid always enlarged TSH, ↓T4, Thyroid Abs present in 90%HypothyroidismRx: Eltroxin
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De Quervains
Rapidly swollen and painful glandLarge amounts of thyroid hormoan
produced= hyperthyroidismMost resolve completely within weeksSome become hypothyroid after
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Diffusely enlarged thyroid
Simple Colloid GoitreGraves diseaseThyroiditis
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Colloid Goitre
Causes Increased physiological demand• Puberty• Pregnancy• Lactation Iodine deficiency Carbimazole
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Graves Disease
Abs v TSH receptorHyperthyroidism +/- thyrotoxicosisIx: Low TSH High T3 and T4 TSH receptor Abs
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Graves Disease
Featureso Eye Signs specific to Graves Lid retraction: Dalrymples sign Lid Lag Exophthalmos Chemosis Ophthalmoplegia Optic atrophy Corneal ulcerationo Pretibial myxoedema: non pitting oedema
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Adenoma
Usually follicularCannot distinguish from follicualr Ca on
FNASurgery to confirm Dx
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Thyroid Ca
PapillaryFollicularMedullaryAnaplasticLymphomaMets
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TMNG
Second most common cause of thyrotoxicosis after Graves
Plummers disease Single toxic adenoma
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Hyperthyroid features
Heat intolerance Palmar erythema Tremor Weight loss Onychyolysis (Plummers nails) – ragged nail
bed edges Increased appetite Tachycardia +/- A Fib Graves: eye signs + pretib myxoedema + thyroid
acropachy
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Ix of Thyroid Disease
Low TSH, High T3 and T4Antibodies: Anti TSH Abs: Graves Anti Thyroid peroxidase: Hashimotos
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Ix of Thyroid Disease
Nuclear Medicine Scan Cold nodule: could be Ca Hot nodule: unlikely to be Ca• US +/- FNA Distinguish solid v cystic
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Hyperthyroid Treatment
Medical Thyrostatics: Propylthyrouracil,
Carbimazole Beta BlockersRadioactive Iodine131 Can cause hypothyroidism
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Thyroid Surgery
Indications Malignancy Obstruction: Pembertons sign, dilated
neck veins, Thoracic inlet obstruction Thyrotoxicosis Cosmesis Retrosternal expansion
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Thyroid Ca
Papillary 80% Young patients Spreads to LNs Can be treated with Lobectomy or total
thyroidectomt
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Thyroid Ca
Follicular 8% Average age 50 years FNA not useful Haematogenous spread Rx: total thyroidectomy and replacement
therapy and radioiodine ablation
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Thyroid Ca
Medullary 7% Parafollicular cells secrete calcitonin 10% familial: MEN II, 90% sporadic Rx: thyroidectomy and calcitonin follow up
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Thyroid Ca
Anaplastic 5% Occurs in elderly Usually T4 on presentation Rx: debulking and XRT
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Cx of Thyroid Surgery
Haematoma RLN palsy SLN palsy Hypoparathyroidism and hypocalcaemia Thyroid storm: pre, intra or post op Prevented by PTU 10/7 pre op Hypothyroidism Infection Keloid scar
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Varicose Veins
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Pathophysiology
Intima and media of vein invaded by fibrous tissue, so venous tone is lost
Valves become incompetent
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Veins Involved
Long Saphenouso Arises anterior to MM, travels on lateral
aspect of leg and joins SFJ 2cm below and lateral
Short Saphenous