Fwd: Thyroid Surgery (Cormac Joyce)

1,778 views

Published on

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

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,778
On SlideShare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
110
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Fwd: Thyroid Surgery (Cormac Joyce)

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

×