THYROID GLAND

BASRA MEDICAL COLLEGE

• Anatomy: The gland consist of right & left lobes connected by a narrow isthmus, both lobes
lies on the front & sides of the trachea & larynx at the level of 5th -7th cervical vertebra
and the isthmus overlay the 2nd -3rd tracheal rings.
• I. Blood supply: a. Arteries: 1.Superior thyroid a. from external carotid a. it runs with
external laryngeal
• nerve. 2.Inferior thyroid a.
• from subclavian a. it runs with recurrent laryngeal nerve. 3.Thyroid ima a. (if present it
arise from bracheocephalic a. or arch of aorta).
• b. Veins: 1. Superior thyroid v. drains to internal jugular vein. 2. Middle thyroid v. drains to
internal jugular vein.
• 3. Inferior thyroid v. into left bracheocephalic v.
BLOOD SUPPLY
Lymphatics
Extensive Anastomose below the capsule
drain to pretracheal (Delphian) and
paratracheal then to deep cervical and
mediastinal lymph nodes.
The clinical importance of the Delphic LN,
is when enlarged, becomes of DDx of
goiter, as it moves with deglutition
 THYROID HISTOLOGY
The functioning unit is the lobule consists of 24–40
follicles lined with cuboidal epithelium. The follicle
contains colloid in which thyroglobulin is stored
The second group of thyroid secretory cells is the C
cells or parafollicular cells, which contain and
secrete the hormone
calcitonin
.
PHYSIOLOGY
• The hormones (T3) and (T4) are bound to thyroglobulin within the colloid.
Synthesis within the thyroglobulin complex is controlled by several enzymes
• 1. Trapping of inorganic iodide from the blood.
• 2. Oxidation of iodide to iodine.
• 3. Binding of iodine with tyrosine to form iodotyrosines.
• 4. Coupling of mono and di-iodotyrosines to form T3 and T4.
• When hormones are required, the complex is resorbed into the cell and
thyroglobulin is broken down. T3 and T4 are liberated and enter the blood,
where they are bound to serum proteins: albumin and thyroxine-binding
globulin (TBG)
The small amount of hormone that remains free in the serum is biologically
active.
90% of the secreted hormones is T4 BUT T3 is the active hormone So, T4 is
converted to T3 peripherally.
 THYROID HORMON FUNCTION
• important for fetal brain development and skeletal maturation
• T3 increases oxygen consumption, basal metabolic rate,and
heat production
• actions of catecholamines are amplified
• increase gastrointestinal (GI) motility
• increase bone and protein turnover and the speed of muscle
contraction and relaxation
• increase glycogenolysis, hepatic gluconeogenesis, intestinal
glucose absorption, and cholesterol synthesis and degradation
TESTS OF THYROID FUNCTION

• Serum TSH (Normal 0.5–5 μU/mL)

Total T4
free t4 (Reference Range 12–28 pmol/L)
free T3 level (3–9 pmol/L)
RESULTS OF THYROID FUNCTION TESTS IN NORMAL AND PATHOLOGICAL STATES .

• Thyroid functional state TSH Free T4 Free

T3 Euthyroid Normal Normal
Normal
• hyperthyroidism Undetectable High
High
• hypothyrodism High Low Low
• T3 toxicity Low/undetectable Normal High
THYROID AUTOANTIBODIES

Serum levels of antibodies against thyroid peroxidase (TPO) and

thyroglobulin are useful in determining the cause of thyroid
dysfunction
Levels above 25 units/mL for TPO antibody. and titres of greater
than 1:100 for antithyroglobulin are considered significant for
autoimmune thyroiditis .
The presence of antithyroglobulin antibody interferes with
assays of serum thyroglobulin
TSH receptor antibodies (TRAB) are often present in Graves’
disease
THYROID IMAGING

Chest and thoracic inlet x-rays

Ultrasound scanning
Computed tomography, magnetic resonance imaging and positron
emission tomography
Isotope scanning
(123I), (99mTc)

Fine-needle aspiration cytology

THYROID ENLARGEMENT

• Goitre : generalized enlargement of the thyroid gland.

• Solitary nodule: discrete swelling in one lobe with no
palpable abnormality elsewhere
• Dominant nodule :Discrete swellings with evidence of
abnormality elsewhere in the gland
• Classification:
1. simple (non toxic): *simple hyperplastic goitre
(colloid). *multinodular goitre.
• 2.toxic goitre:
*diffuse (grave’s disease).
• *toxic nodule.
*toxic multinodular.
• 3.inflammatory:
*deQuervain’s thyroiditis (sub acute).
*Riedel’s thyroiditis.
• 4.autoimmune:
• *Hashimoto’s thyroiditis.
5.neoplastic goitre :
*adenoma (benign).
• *papillary Ca (malignant).
• *follicular Ca.
*anaplastic Ca.
*medullary Ca
lymphoma
SIMPLE GOITRE
• Either endemic or sporadic
diffuse or nodular
Aetiology
*Physiological: puberty& pregnancy.
• , Iodine deficiency (endemic goiter)
• Dyshormonogenesis defective hormone synthesis (sporadic goiters)
• Goitrogens (cabbage, kale and rapeseed), which contain Thiocyanates
interfere with iodide trapping
• Para amino salycilic acid (pas) , antithyroid interfere with oxidation of
iodide and binding of iodine to tyrosine
inappropriate secretion of TSH from microadenoma in the anterior
pituitary (rare)
NODULAR GOITRE

• as a result of fluctuating stimulation

• Nodules are usually multiple
• Nodules may be colloid or cellular, and cystic
degeneration and haemorrhage are common, as is
subsequent calcification
• Nodules appear early in endemic goitre and later in
sporadic goitre
• All types of simple goitre are more common in the
female than in the male owing to the presence of
DIAGNOSIS

• History :age , sex , pregnancy status , The patient is euthyroid, only

symptom is neck swelling , hx of ingestion of goitrogens
• Examination : The nodules are palpable and often visible
• ; they are smooth, usually firm and not hard,
• the goitre is painless and moves freely on swallowing.
• Hardness and irregularity, due to calcification, may simulate carcinoma.
• A painful nodule, or rapid enlargement of a nodule raises suspicion of
carcinoma but is usually due to haemorrhage into a simple nodule
COMPLICATIONS

• Tracheal obstruction
• Retrosternal extension
• Secondary thyrotoxicosis
• Carcinoma usually follicular
PREVENTION AND TREATMENT OF
SIMPLE GOITRE
• Prevention:
iodised salt.
• In the early stages, a hyperplastic goitre may regress if thyroxine
is given in a dose of 0.15–0.2 mg daily for a few months
• nodular stage of simple goitre is irreversible
Operation indications
cosmetic , pressure symptoms, patient anxiety. Retrosternal extension
dominant area of enlargement that may be neoplastic.
total thyroidectomy with immediate and lifelong replacement
of thyroxine
•
Thank you