009 Thyroid - Introduction to Clinical Surgery Lectures

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Lecture on the thyroid from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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009 Thyroid - Introduction to Clinical Surgery Lectures

  1. 1. Thyroid Nick Harvey
  2. 2. Thyroid: Physiology
  3. 3. Thyroid: Differential Diagnosis Nodular Toxic Goitre >45 Nodular enlagement Toxic symptoms Eye signs? Nodular Simple Goitre 30-45 Nodular enlargement Malignant Solitary ‘cold’ nodule Papillary Follicular Medullary Anaplastic Diffuse Toxic Goitre 15-30 Diffuse enlargement Toxic symptoms Eye signs Diffuse Simple Goitre 15-30 Diffuse enlargement
  4. 4. Thyroid: History <ul><li>Onset, Course, Duration </li></ul><ul><li>Painful or Painless </li></ul><ul><li>Other lumps </li></ul><ul><li>Cause </li></ul><ul><li>Effect on General Condition </li></ul><ul><ul><li>Symptoms and signs of thyrotoxicosis </li></ul></ul><ul><ul><li>Compression of surrounding structures </li></ul></ul><ul><ul><ul><li>Dyspnoea </li></ul></ul></ul><ul><ul><ul><li>Dysphagia </li></ul></ul></ul><ul><ul><ul><li>Hoarse voice </li></ul></ul></ul>
  5. 5. Thyroid: Symptoms & Signs <ul><li>Nervous </li></ul><ul><ul><li>Nervousness, irritable, insomnia, tremors </li></ul></ul><ul><li>Cardiovascular </li></ul><ul><ul><li>Palpitations, dyspnoea, ankle swelling, AF </li></ul></ul><ul><li>Alimentary </li></ul><ul><ul><li>Increased appetite, weight loss, diarrhoea </li></ul></ul><ul><li>Metabolic </li></ul><ul><ul><li>Preference for cold weather, sweating, menstrual disturbances, impotence </li></ul></ul>
  6. 6. Thyroid: Examination Inspection <ul><li>Site </li></ul><ul><li>Size </li></ul><ul><li>Shape </li></ul><ul><li>Symmetry </li></ul><ul><li>Surface </li></ul><ul><li>Skin overlying </li></ul><ul><li>Scars </li></ul><ul><li>Special signs </li></ul><ul><ul><li>Movement with deglutition </li></ul></ul>
  7. 7. Thyroid: Examination Palpation <ul><li>Tenderness </li></ul><ul><li>Skin temperature </li></ul><ul><li>Size </li></ul><ul><li>Surface </li></ul><ul><ul><li>Smooth, irregular </li></ul></ul><ul><li>Edge </li></ul><ul><ul><li>Well-defined, ill-defined </li></ul></ul><ul><li>Consistency </li></ul><ul><ul><li>Cystic, solid </li></ul></ul><ul><li>Relationship to surrounding structures </li></ul><ul><ul><li>Skin, muscles </li></ul></ul><ul><li>Draining lymph nodes </li></ul><ul><li>Special signs </li></ul><ul><ul><li>Central trachea? </li></ul></ul>
  8. 8. Thyroid: Examination Percussion & Auscultation <ul><li>Percuss </li></ul><ul><ul><li>Retrosternal goitre? </li></ul></ul><ul><li>Auscultation </li></ul><ul><ul><li>Bruit? </li></ul></ul>
  9. 9. Thyroid: Examination Eye Signs <ul><li>Lid retraction </li></ul><ul><li>Lid lag </li></ul><ul><li>Exophthalmos </li></ul>

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