Fwd: Thyroid Surgery (Cormac Joyce)

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From: UCD Graduate '09 None <ucdgrad09@gmail.com&gt;
Date: 2009/2/25
Subject: Thyroid Surgery (Cormac Joyce)
To: ucdgrad09@gmail.com

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  • 1. Thyroid Cormac Joyce November 21 st 2008
  • 2. Thyroid
    • Causes of solitary thyroid nodule:
    • Prominent nodule in MNG
    • Cyst
    • Follicular adenoma
    • Carcinoma
    • Thyroiditis
  • 3. Thyroiditis
    • Inflammation of thyroid gland
    • Causes
    • Hashimotos
    • De Quervains
  • 4. Hashimotos
    • Chronic Lymphocytic Thyroiditis
    • Thyroid always enlarged
    •  TSH, ↓T4, Thyroid Abs present in 90%
    • Hypothyroidism
    • Rx: Eltroxin
  • 5. De Quervains
    • Rapidly swollen and painful gland
    • Large amounts of thyroid hormoan produced= hyperthyroidism
    • Most resolve completely within weeks
    • Some become hypothyroid after
  • 6. Diffusely enlarged thyroid
    • Simple Colloid Goitre
    • Graves disease
    • Thyroiditis
  • 7. Colloid Goitre
    • Causes
    • Increased physiological demand
    • Puberty
    • Pregnancy
    • Lactation
    • Iodine deficiency
    • Carbimazole
  • 8. Graves Disease
    • Abs v TSH receptor
    • Hyperthyroidism +/- thyrotoxicosis
    • Ix:
    • Low TSH
    • High T3 and T4
    • TSH receptor Abs
  • 9. Graves Disease
    • Features
    • Eye Signs specific to Graves
    • Lid retraction: Dalrymples sign
    • Lid Lag
    • Exophthalmos
    • Chemosis
    • Ophthalmoplegia
    • Optic atrophy
    • Corneal ulceration
    • Pretibial myxoedema: non pitting oedema
  • 10. Adenoma
    • Usually follicular
    • Cannot distinguish from follicualr Ca on FNA
    • Surgery to confirm Dx
  • 11. Thyroid Ca
    • Papillary
    • Follicular
    • Medullary
    • Anaplastic
    • Lymphoma
    • Mets
  • 12. TMNG
    • Second most common cause of thyrotoxicosis after Graves
    • Plummers disease
    • Single toxic adenoma
  • 13. 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
  • 14. Ix of Thyroid Disease
    • Low TSH, High T3 and T4
    • Antibodies:
    • Anti TSH Abs: Graves
    • Anti Thyroid peroxidase: Hashimotos
  • 15. Ix of Thyroid Disease
    • Nuclear Medicine Scan
    • Cold nodule: could be Ca
    • Hot nodule: unlikely to be Ca
    • US +/- FNA
    • Distinguish solid v cystic
  • 16. Hyperthyroid Treatment
    • Medical
    • Thyrostatics: Propylthyrouracil, Carbimazole
    • Beta Blockers
    • Radioactive Iodine131
    • Can cause hypothyroidism
  • 17. Thyroid Surgery
    • Indications
    • Malignancy
    • Obstruction: Pembertons sign, dilated neck veins, Thoracic inlet obstruction
    • Thyrotoxicosis
    • Cosmesis
    • Retrosternal expansion
  • 18. Thyroid Ca
    • Papillary
    • 80%
    • Young patients
    • Spreads to LNs
    • Can be treated with Lobectomy or total thyroidectomt
  • 19. Thyroid Ca
    • Follicular
    • 8%
    • Average age 50 years
    • FNA not useful
    • Haematogenous spread
    • Rx: total thyroidectomy and replacement therapy and radioiodine ablation
  • 20. Thyroid Ca
    • Medullary
    • 7%
    • Parafollicular cells secrete calcitonin
    • 10% familial: MEN II, 90% sporadic
    • Rx: thyroidectomy and calcitonin follow up
  • 21. Thyroid Ca
    • Anaplastic
    • 5%
    • Occurs in elderly
    • Usually T4 on presentation
    • Rx: debulking and XRT
  • 22. 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
  • 23. Varicose Veins
  • 24. Pathophysiology
    • Intima and media of vein invaded by fibrous tissue, so venous tone is lost
    • Valves become incompetent
  • 25. Veins Involved
    • Long Saphenous
    • Arises anterior to MM, travels on lateral aspect of leg and joins SFJ 2cm below and lateral
    • Short Saphenous