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Thyroid Swelling

The document discusses examination and evaluation of thyroid swelling. It outlines inspection of the hands, eyes, thyroid gland, legs, and scar if present. Differential diagnoses are provided including nodular goiter, multinodular goiter, thyroid cancer, and lymphadenopathy. Investigations like blood tests, ultrasound, CT scan, and FNAC are recommended. Management depends on diagnosis and may include hemithyroidectomy, total thyroidectomy, lymph node dissection, and postoperative care and follow up. Complications, anatomy, pharmacology, and specific conditions like Graves' disease are also outlined.

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Shafiq Zahari
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709 views4 pages

Thyroid Swelling

The document discusses examination and evaluation of thyroid swelling. It outlines inspection of the hands, eyes, thyroid gland, legs, and scar if present. Differential diagnoses are provided including nodular goiter, multinodular goiter, thyroid cancer, and lymphadenopathy. Investigations like blood tests, ultrasound, CT scan, and FNAC are recommended. Management depends on diagnosis and may include hemithyroidectomy, total thyroidectomy, lymph node dissection, and postoperative care and follow up. Complications, anatomy, pharmacology, and specific conditions like Graves' disease are also outlined.

Uploaded by

Shafiq Zahari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

THYROID SWELLING

Thyroid Examination

Inspection of hand
- Sweaty or dry palms
- Palmar erythema
- Fine tremors
- Thenar/Hypothenar Muscle
- Thyroid Acropachy
- Pulse
- Proximal Myopathy

Inspection of Eye
- Exophthalmos (front, lateral and above)
- Eye Movement
- Lid Lag
- Lid Retraction (from lateral view)
- Loss of outer 1/3rd of eyebrows

Thyroid
- Inspect and Describe lump (movement on deglutition and protrusion of tongue, site,
number, size, shape, overlying skin, scars)
- Palpate from behind, find thyroid cartilage, then cricoid cartilage, then locate the
isthmus
- Palpate each lobe and describe (size, site, shape, movement with swallowing,
tenderness, temperature, consistency, edge, surface, lower border palpable,
mobility)
- Fixation to Sternocleidomastoid and skin
- Tracheal Deviation
- Percuss retrosternal
- Auscultate for thyroid bruits, carotid bruit
- Cervical lymphadenopathy, supraclavicular

Inspect Leg
- Pretibial Myxoedema
- Proximal Myopathy
- Deep Tendon Reflex

If there is thyroidectomy scar, check for signs of hypothyroidism


- Chvostek’s sign
- Trousseau’s sign
- Hoarseness of voice
Differentials
- Simple Nodular Goitre
o Follicular Adenoma
o Thyroid Cyst
o Thyroiditis
- Multi Nodular Goitre
- Thyroid CA
o Follicular
o Medullary
o Papillary
o Anaplastic
o Hurthle Cell Type
o Lymphoma
- Lymphadenopathy
- Thyroglossal cyst
- Sebaceous cyst
- Lipoma

Investigation
- TFT – TSH level, T4 and T3
- FBC – haemoglobin, haematocrit,
- Blood Grouping – GSH, GXM
- Pre-operative assessment (LFT, ECG, CXR, RP, FBS, FPL, etc)
- Ultrasound of neck – thyroid origin, site, number, consistency, lymph nodes (*cyst –
drain and palpate for residual lump)
- CXR – look for tracheal deviation
- CT Scan – staging, retrosternal extension
- FNAC – cytological findings, confirm tissue type. (follicular, papillary, anaplastic,
medullary, lymphoma)

Management
- Follicular if one sided, Hemithyroidectomy, then send for HPE, if got capsular or
vascular invasion, do completion total thyroidectomy, lymph node dissection
- If MNG, papillary, medullary straight total thyroidectomy, lymph node dissection
- Post-Operative Complication
o Haemorrhage with Hematoma
o Recurrent laryngeal nerve injury – Stridor and hoarseness
o Hyperthyroidism
o Tracheomalacia
o Infection
o Hypoparathyroidism – perioral numbness, chovstek’s sign, trousseou’s sign
o Hypothyroidism
o Permanent hypoparathyroidism
o Hypertrophic Scar and Keloid
- Cancer follow up –whole body scan for micro metastasis – TSH Suppression dose,
Radio iodine ablation. starts on thyroxine replacement therapy
- Thyroglobulin marker for recurrence
-

MEN 2A
- Medullary Thyroid
- Pheochromocytoma
- Hyperparathyroidism

MEN 2B
- Medullary Thyroid
- Pheochromocytoma
- Neurocutaneous Neoplasm

Thyroid Anatomy
- Pretracheal fascia (attached to larynx) and Paratracheal fascia
- Superior and inferior, thyroidea ima artery
- Right and left lobe, pyramidal lobe
- Superior laryngeal nerve – high pitch voice
- Recurrent laryngeal nerve – hoarseness of voice, stridor

Thyroid Pharmacology

Anti Thyroid – Methimazole, Carbimazole, Propylthiouracil


Thyroid Replacement – Levothyroxine
ADR anti-thyroid – agranulocytosis

Grave’s Disease – RAI, Total Thyroidectomy (contraindicated in pregnancy, reproductive


age)

Haematoma post thyroidectomy – compress the veins, leads to laryngeal oedema,


respiratory distress.. manage by off suture completely , superficial skin and fascial closure.

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