This document discusses the thyroid gland, thyroid hormones, and various thyroid conditions. It covers thyroid anatomy, development of thyroid hormones, and their regulation. It also classifies different types of goiters and thyroid disorders like hypothyroidism, hyperthyroidism, nodular goiter, and thyroiditis. Investigation methods and treatment approaches for various thyroid diseases are outlined. Complications of thyroid surgery are also mentioned.

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Thyroid development

3. Thyroid anatomy

4. Thyroglossal cyst

5. Thyroid hormones
 From follicular cells
 Tri iodo thryronine T3
 Thyroxin T4
 From parafollicular cells
 Calcitonin

6. Synthesis of thyroid hormones
 Trapping of inorganic iodide from blood
 Oxidation of iodide to iodine
 Binding of iodine with tyrosine molecule of thyroglobulin
to form MIT & DIT
 Coupling of MIT and DIT to form T3 and T4

7. Regulation of thyroid hormones
TRH(Hypothalamus)
TSH(Anterior Pituitary)
T3 & T4(thyroid gland)
Negative feed back

8. Investigations
 Thyroid function test
 Serum T3, T4 & TSH levels
 Ultrasound of neck
 FNAC
 X-ray neck
 Thyroid scan
 Tc 99m
 I-123
 Thyroid antibodies

9. Classification of goitre
 Simple goitre
 Toxic goitre
 Neoplastic goitre
 Inflammatory goitre

10. Classification of goitre
 Simple goitre
 Diffuse hyperplastic goitre
 Colloid goitre
 Nodular goitre
 Solitary nodule
 Multinodular goitre
 Toxic goitre
 Diffuse toxic goitre (Graves disease-Primary thyrotoxicosis)
 Toxic multinodular goitre (Secondary thyrotoxicosis)
 Toxic adenoma

11. Classification of goitre
 Neoplastic goitre
 Benign
 Adenoma
 Malignant
 Papillary carcinoma
 Follicular carcinoma
 Meduallary carcinoma
 Lymphoma
 Thyroiditis
 Hashimoto’s thyroiditis(autoimmune)
 de Quervain’s thyroiditis(granulomatous)
 Reidel’s thryroiditis(Fibrosing)
 Infective thyroiditis(Bacterial, viral)

12. Hypothyroidism
 Cretinism in infancy & Myxedema in adults

13. Hypothyroidism
Causes
 Primary
 Thyroiditis
 Iatrogenic
 Endemic
 Congenital
 Goitrogens
 Secondary
 Hypopituitarism
 Hypothalamic hypothyroidism
 Peripheral resistance to thyroid hormones

14. Hypothyroidism
 Clinical features
 Tirednesss
 Weight gain
 Cold intolerance
 Constipation
 Dry coarse hair
 Periorbital puffines
 Hoarse voice
Investigations
 T3, T4 and TSH
 Treatment
 Oral thyroxine (0.1-0.2mgs

15. Myxoedema
 Severe accentuated symptoms of hypothyroidism in adults
 Puffy face, pouting lips, malar flush
 Dry skin
 Hypothermia
 Bradycardia
 Hypotension
 Myxoedemic coma

16. Hyperthyroidism

17. Hyperthyroidism
 Diffuse toxic goitre(Grave’s disease)
 Exophthalmos
 Heat intolerance
 Irritatability, nervousness, tremors
 Palpitations
 Diarrhoea
 Oligomenorrhoea
 Investigations
 Serum T3, T4 and TSH
 Thyroid scan
 Treatment
 Antithyroid drugs
 Surgery
 Radioiodine therapy

18. Nodular goitre
 Solitary nodule
 Multiple nodules(multinodular goitre)
Treatment
Hemithyroidectomy for solitary benign nodule
Subtotal thyroidectomy for multinodular goitre

19. Neoplastic goitres
 Follicular adenoma
 Hemithyroidectomy
 Papillary carcinoma
 Total thyroidectomy
 Follicular carcinoma
 Total thyroidectomy
 Medullary carcinoma
 Total thyroidectomy

20. Complications of thyroid surgery
 Haemorrhage
 Injury to recurrent laryngeal nerve
 Tetany(hypoparathyroidism)
 Thyrotoxic crisis(storm)
 Following surgery in a patient with inadequately controlled
hyperthyroidism
 High grade fever
 Tachycardia
 Sweating
 Hypotension
 Treatment
 Intravenous fluids, cold sponging, intravenous propranolol,
steroids and antithyroid drugs

21. Thyroiditis
 Hashimoto’s thyroiditis (chronic lymphocytic)
 Diffuse enlargment
 May be painful
 Develop hypothyroidism eventually
 Diagnosed by FNAC and raised levels of thyroid antibodies
 Treated by thyroxine replacement

22. Thank you