2. 1st thyroid surgery: Robert
Frugard in 1170
Most Notable thyroid surgeons:
Emil Theodor Kocher & CA
Theodor Billroth
Kocher: Nobel prize in 1909 for
his work on physiology,
pathology & surgery of thyroid
gland
3. Develops from columnar cells of pharyngeal floor between 1st and 2nd
pharyngeal pouches (future Foramen Caecum)
Formation of tube which gets canalized (Thyroglossal duct)
Displaced forward by the developing hyoid, F/B descent slightly to left
Bifurcates to form Two Lateral Lobes
Obliteration of remaining duct (except for a part on left side forming
Pyramidal Lobe)
Note: Calcitonin Producing C Cells arise from 4th pharyngeal pouch, migrate
from neural creast into the thyroid via Ultimo-Branchial Bodies
5. •Anterior triangle of the neck.
•butterfly- shaped appearance.
•Extent: C5-T1 vertebra
•Isthmus: 2nd to 4th tracheal ring
•Pyramidal Lobe: upward
extension as fibrous strands or
muscular strands from junction of
isthmus and left lateral lobe
•Capsule of thyroid:
a) True: peripheral
condensed connective
tissue
b) False: derived from pre
tracheal layer of deep
cervical fascia
Berry’s Ligament: strong
condensed vascular connective
tissue between lateral lobes and
cricoid cartilage
6. Superior Thyroid Artery: first ant
branch of external carotid artery,
supplies upper 1/3rd of lobe and
upper half of isthmus
Inferior Thyroid Artery: a branch
of Thyrocervical trunk of
subclavian artery. Supplies lower
2/3rd of lobe and lower half of
isthmus
Thyroidea Ima artery: branch of
aorta or brachiocephalic artery
Tracheal and oesophageal
branches
Acessory thyroid artery
7. Superior thyroid vein:
accompanies sup thyroid
artery, joins IJV or common
facial vein
Middle thyroid vein: drains
into IJV, 1st to be ligated
during thyroid surgery
Inferior Thyroid vein: joins
left brachiocephalic veins
Kochers (4th throid) vein:
found between middle and
inf thyroid veins, joins the
IJV
14. Calorigenic actions BMR
(stimulation of oxygen consumption by tissues)
Adipose tissues (catabolic lipolysis )
and cholesterol
protein breakdown)
heat production 2ry to
energ
y
Muscle (catabolic
Body
temperature (
production)
Bone, skeletal muscle and nervous system
(normal development).
15. sensitivity
to
Heart (upregulation of β receptor
and circulating catecholamines).
CNS stimulation resulting in anxiety, restlessness,
insomnia and tremors.
All these actions are remarkable in patients with abnormally hyperthyroidism
21. Exophthalmos
Apparent True
Widening of palpebral
fissure due to spasm
muller’s muscle
Infiltration of retro
bulbar tissue with
inflammatory cells
and accumulation of
inflammatory fluids
22.
23. ( C ) LOCAL EXAMINATION OF THYROID
The examination consists of :
1 Inspection
With neck in neutral or slightly extended
2 Palpation
With neck slightly flexed
•Examine for size, site , surface , shape and presence of nodules ,
skin overlying , mobility, consistency .
•3- Auscultation for bruit
•Note: An enlarged thyroid is referred to as a goiter. There is no direct
correlation between size and function- a person with a goiter can be
euthyroid, hypo- or hyperthyroid. A normal thyroid is estimated to be
10 grams with an upper limit of 20 grams .
24.
25. INSPECTION
1. The patient should be
seated or standing in a
comfortable position
with the neck in a
neutral or slightly
extended position.
2. To enhance visualization
of the thyroid, you can:
• Extending the neck
(pizillos method),
which stretches
overlying tissues
• Have the patient
swallow a sip of
water, watching for
the upward
movement of the
thyroid gland.
26.
27. LATERAL APPROACH (LAHEYS METHOD)
1. Lateral pushing of the
thyroid, and palpation
of the opposite side
2. Estimate the smooth,
straight contour from
the cricoid cartilage
to the suprasternal
notch.
28. PALPATION: ANTERIOR APPROACH
• The patient is examined
in the seated or
standing position.
• Attempt to locate the
thyroid isthmus by
palpating between the
cricoid cartilage and the
suprasternal notch.
• Use one hand to slightly
retract the sternomastoid
muscle while using the
other to palpate the
thyroid.
• Have the patient
swallow a sip of water
as you palpate, feeling
for the upward
movement of the thyroid
gland.
29. PALPATION: POSTERIOR APPROACH
• The patient is examined in
the seated or standing
position.
• Standing behind the
patient, attempt to locate
the thyroid isthmus by
palpating between the
cricoid cartilage and the
suprasternal notch.
• Have the patient swallow a
sip of water as you
palpate, feeling for the
upward movement of the
thyroid gland.
31. 1. Serum TSH:
Delineation of Hypo & Hyperthyroidism V/s Euthyroid state
Can Detect Subclinical Hypo/Hyperthyroidism
2. Serum T3 & T4:
Free T3 & T4 are more accurate as total T3 & T4 varies according to serum
protiens
3. Serum Calcitonin:
Only useful in patients with suspected MEN 2 synd or medullary ca thyroid
Not indicated for routine screening of every thyroid case
4. Radioactive Iodine Uptake:
I 123 is used
Less widely used now-a-days due to ultrasensitive TSH, T3, T4 investigations
Only indication is to detect functioning thyroid cancer metastasis after
remnant iodine ablation
5. Thyroid Autoantibody Levels:
Thyroid Stimulating Immunoglobulin, Anti-microsomal Ab & Anti-Thyroid
peroxidase Abs
Evaluation of autoimmune conditions like Graves and Hashimoto Thyroiditis
