This document discusses the thyroid gland and various thyroid conditions. It begins by explaining what the thyroid gland does, producing hormones that regulate metabolism. It then discusses different types of goiters (enlargement of the thyroid gland), including diffuse goiter, multi-nodular goiter, and solitary thyroid nodules. For each condition, it covers causes, symptoms, diagnostic evaluation, and treatment approaches. Key points are that toxic goiters are rarely malignant, solitary nodules need evaluation to exclude cancer, and surgery is rarely needed for autoimmune or inflammatory thyroid diseases.

1. Mr. Adeel Abbas

3. Simon’s Triangle..???

5. What Does Your Thyroid
Gland Do for You?

6. Produces Two Hormones Called
• Thyroxine (T4)
• Thyronine (T3)
• Regulates Metabolism so Your Cells Function
Properly
Affects Every Cell in the Body

7. Goitre
Enlargement Of The Thyroid Gland (Local Or Diffuse)
Based On Hyperplasia Or Degeneration.

8. Classification
Diffuse Goitre.
Multi-Nodular Goitre.
Solitary Thyroid Nodule.

9. Diffuse Goitre
More Commonly Non-Toxic.
May be Toxic.

10. Diffuse Non-Toxic Goitre
Compensatory Hypertrophy & Hyperplasia due to
Decrease in T3 & T4.
Diffusely Involves Whole Gland.
Not Associated With
Hypo OR Hyperthyroidism.

11. Causes
Physiological Goitre:
Puberty OR Pregnancy.
Dietary Iodine Deficiency:
In Areas Far From Sea.
Dietary Goitrous Agents:
Cabbage & Turnips.
Calcium or Flouride in water.
PAS, Lithium, Phenylbutazone, Thiouracil, Carbimazol.

12. Causes cont:
Hereditary.
Treated Graves’ Disease.
Rare Cause:
Lymphoma.
Anaplastic.
Thyroiditis (Autoimmune or de-Quervain’s).
Amyloidosis.

13. Treatment
Small:
No Treatment.
Reassurance.
Iodine Support.
Large/Pressure Symptoms OR Cosmesis:
Near-Total Thyroidectomy.

14. Fate (of Diffuse Non-Toxic Goitre)
Revert to Normal.
Stays the Same.
Progress to Multi-Nodular Goitre.

15. Multi-Nodular Goitre
Progression from Diffuse Simple Goitre.
Upto 2 kg.
Multinodular Focal Hyperplasia.
Mostly Euthyroid.

16. Causes
Progressive Enlargement of Diffuse Goitre.
Sporadic.
Previous Irradiation to Neck.

17. Pathological Features
Colloid Abundant.
Follicular cells have round to oval nuclei.
Follicle cell cytoplasm is scant.
Inflammation.
Infarction.
Haemorrhage.
Fibrosis.
Calcification.
Cyst Formation.

18. Clinical Presentation
Cosmetic.
Discomfort..
Irritating Cough.
Dysphagia.
Wish to Exclude Malignancy.
Hyperthyroidism.
Hoarseness.

19. Complications
Local Symptoms:
Stridor / Dysphagia / Retrosternal Enlargement /
Cosmesis.
Toxicity.
Malignant Change (5%).
Haemorrhage into Cyst.

20. Treatment
Medical:
Thyroxine.
Surgery:
Total Thyroidectomy.
Near-Total Thyroidectomy.

21. Solitary Thyroid Nodule
5% of Adult Population.
50% Large Nodule in MNG.
50% True Solitary.
80% are Adenomas.
10% Carcinomas.
10% Cyst / Fibrosis / Thyroiditis.

22. Management
Full Clinical Assessment including;
TFT.
Ultrasound.
FNAC.

23. Treatment
Colloid Cyst:
Repeat FNAC & Reassurance.
Simple Cyst:
<4cmm  Reassurance.
>4cm  Lobectomy.
Follicular Cells:
Lobectomy  Completion Thyroidectomy.
Papillary Carcinoma:
Total Thyroidectomy.

24. Investigating Thyroid
Most Sensible & Universal Investigations;
Ultrasound.
FNAC.

25. Antibodies.
Serum Cholesterol.
CXR.
Iodine Isotope Scan.
IDL.
Bronchoscopy.

28. Key Points
Toxic Goitre are Rarely Malignant.
All Solitary Goitre Need to Exclude Malignancy.
Surgery is Rarely Needed in Autoimmune or
Inflammatory Thyroid Disease.