Thyroid is a butterfly-shaped gland located in the front of the neck, just below the Adam's apple. It is an essential part of the endocrine system, responsible for producing, storing, and releasing hormones that play a crucial role in regulating various bodily functions. The two main hormones produced by the thyroid gland are triiodothyronine (T3) and thyroxine (T4).
The thyroid gland is controlled by the pituitary gland, a small gland located at the base of the brain. The pituitary gland releases thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce and release T3 and T4. These hormones are vital for the body's metabolism, energy production, growth, and development.
Thyroid disorders are relatively common and can arise when the gland produces too much or too little of the thyroid hormones. Some common thyroid conditions include:
1. Hypothyroidism: This occurs when the thyroid gland produces insufficient T3 and T4, leading to a slowdown in metabolism. Symptoms may include fatigue, weight gain, cold intolerance, constipation, and depression.
2. Hyperthyroidism: In this condition, the thyroid gland overproduces T3 and T4, causing an accelerated metabolism. Symptoms can include weight loss, increased heart rate, anxiety, irritability, and heat intolerance.
3. Goiter: A goiter is an enlargement of the thyroid gland, often caused by iodine deficiency or certain thyroid disorders.
4. Thyroid nodules: These are small lumps or growths that can develop within the thyroid gland. Most thyroid nodules are benign, but some may be cancerous.
5. Thyroid cancer: Although relatively rare, thyroid cancer can occur when abnormal cells within the thyroid gland grow and divide uncontrollably.
Diagnosis of thyroid disorders typically involves blood tests to measure thyroid hormone levels and TSH levels, as well as imaging studies such as ultrasound or a radioactive iodine scan.
Treatment for thyroid disorders varies depending on the specific condition but may include medications to regulate hormone levels, radioactive iodine therapy, surgical removal of part or all of the thyroid gland (thyroidectomy), or external beam radiation therapy in the case of thyroid cancer.
It is crucial to have any suspected thyroid problems evaluated and treated by a qualified healthcare professional, typically an endocrinologist, to ensure proper management and prevent complications. With appropriate medical care, many thyroid disorders can be effectively controlled, allowing individuals to lead healthy and fulfilling lives.
Surgical Management of Thyroid Diseases
Toxic Goitre
Primary - Graves’ Disease
Secondary -Toxic Multinodular goitre -Plummer Disease
Autonomous Toxic nodule
Graves Disease - Mainly managed medically
Surgery - Total thyroidectomy
Eye signs will get worse with subtotal
Toxic MNG - Main treatment is surgery -Total thyroidectomy
Autonomous Toxic nodule - Hemithyroidectomy
4. Paradoxical goiter -enlarged thyroid as a result of
very high intakes of iodine
Occurs in Japan and China with high intake of
seaweed (50,000 - 80,000 mg/day)
5. Other classification
I -palpation struma - in normal posture of head it cannot be
seen,only on palpation
II-struma is palpative and can be easily seen
III-struma is very big and is retrosternal. Pressure and
compression marks
6. Incidence
Daily iodine requirement= 0.1- 0.15mg
Endemic goitre occur in geographical areas
with iodine-depleted soil, usually regions
away from the sea coast
Common in central Asia and central Africa ,certain
areas of Australia, including Tasmania and areas
along the Great Dividing Range
8. Etiology
MC- iodine deficiency
In countries that use iodized salt, Hashimoto's thyroiditis
becomes the most common cause
Hypothyroid
Congenital hypothyroidism
Ingestion of goitrogens such as cassava
Side-effects of pharmacological therapy
Hyperthyroid
Graves' disease
Thyroiditis (acute or chronic)
Thyroid cancer
10. Symptoms
Without any hormonal abnormalities, no symptoms
Anterior neck mass
Large masses compression of the local structure
Difficulty in breathing /swallowing
11. Toxic goitres present with
symptoms such as
palpitations, hyperactivity,
weight loss despite
increased appetite, and
heat intolerance
15. Types of thyroidectomy
All thyroid surgeries can be
assembled from three basic
elements
Total lobectomy
Isthmusectomy
Subtotal lobectomy
16. Total thyroidectomy=
2 x total lobectomy+ Isthmusectomy
Subtotal thyroidectomy=
2 x subtotal lobectomy+ Isthmusectomy
Near-total thyroidectomy=
total lobectomy+ subtotal lobectomy+ Isthmusectomy
Lobectomy= total lobectomy+ Isthmusectomy
17. Steps of Thyroidectomy
Exposure-horizontal neck incision, +/- raising of flaps, +/- division of
strap muscles
Identification of structures -Recurrent and ext. branch of superior
laryngeal nerve, parathyroid glands
Devascularisation
Superior thyroid artery
Inferior thyroid artery while protecting the supply to the parathyroids
Thyroid ima if present
Resection
Exploration of other pathology
Closure
19. Potential complications after thyroid surgery
Laryngeal Nerve Injury
Parathyroid Deficit
Postoperative Bleeding
Infrequent Postoperative Complications
Sympathetic nerve injury- results in the development of Horner's
syndrome
Chylous fistula- damage to the thoracic duct
Thyroid storm-resulting from hyperactivity of the thyroid gland
20. hypoparathyroidism
Symptoms
Tingling in the lips, fingers, and toes
Dry hair, brittle nails, and dry, coarse skin
Muscle cramps
Loss of memory
Headaches
Severe muscle spasms (also called tetany)
Convulsions
Treatment
Calcium carbonate
Vitamin D supplements
21. •After sub total resection thyroxine is given to
suppress TSH secretion
•Radioactive iodine may reduce size of recurrent
nodular goitre
22. Prevention
Introduction of Iodized salts
Avoidance of goitrogens (cabbage, turnips,
peanuts, soybeans)
In early (Hyperplastic) stage thyroxine 0.15-
0.2mg
Most multinodular goitre are asymptomatic and
do not require surgery
