THYROID & LYMPH NODES
SWELLING
R. PRIYA DHARSHINI
FAHS
ANATOMY OF THYROID GLAND
HORMONES OF THYROID GLAND
PHYSIOLOGY OF THYROID GLAND
FACTORS THAT AFFECT THYROID
FUNCTION
CLASSIFICATION OF THYROID
SWELLINGS
SIMPLE GOITRE (EUTHYROID)
Physiological - Pubertal ,Pregnancy
Diffuse hyperplasic - Multinodular goitre
TOXIC GOITRE
• Diffuse (Graves’ disease)
• Multinodular
• Toxic adenoma
NEOPLASTIC
• Benign
• Malignant
INFLAMMATORY
• Autoimmune - i) Chronic lymphocytic thyroiditis ii)
Hashimoto’s disease
• Granulomatous (De Quervain’s thyroiditis)
• Fibrosing (Riedel’s thyroiditis)
• Infective - i) Acute (bacterial thyroiditis, viral thyroiditis,
‘subacute thyroiditis’) ii) Chronic (tuberculous,
syphilitic)
HISTORY
EXAMINATION
INVESTIGATION
• Thyroid-Stimulating Hormone (TSH) : essential. If normal, no
need to check freeT3 &T4 levels.
• FreeT3 &T4 : only if TSH level is abnormal.
• Anti-Thyroid Antibodies (antibodies against thyroid peroxidase &
thyroglobulin) : for diagnosis of autoimmune (lymphocytic)
thyroiditis.
THYROID IMAGING
• Ultrasound scan :
Gives good image of thyroid &
regional lymph nodes .
More targeted needle aspiration for
cytology.
• Computerized Tomography (CT),
Magnetic Resonance Imaging (MRI),
Positron Emission Tomography
(PET) :
Only for selected cases, e.g. known
malignancy, retrosternal goitre,
recurrent goitre.
FINE NEEDLE ASPIRATION
CYTOLOGY
MANAGEMENT
THYROIDECTOMY - INDICATIONS
THYROIDECTOMY - TYPES
INTRODUCTION
• Lymph nodes are small glandular structures located in the course
of lymph vessels.
• The lymph nodes are also called lymph glands or lymphatic
nodes.
STRUCTUTRE OF LYMPH NODES
• Each lymph node
constitutes masses of
lymphatic tissue, covered by
a dense connective tissue
capsule.
• The structures are arranged
in three layers namely
cortex, paracortex and
medulla
FUNCTIONS OF LYMPH NODES
• Lymph nodes serve as filters which filter bacteria and toxic
substances from the lymph. Functions of the lymph nodes are:
• When lymph passes through the lymph nodes, it is filtered, i.e.
the water and electrolytes are removed. But, the proteins and
lipids are retained in the lymph.
• Bacteria and other toxic substances are destroyed by
macrophages of lymph nodes. Because of this, lymph nodes are
called defense barriers.
SWELLING OF LYMPH NODES
• During infection or any other processes in a particular region of the
body, activities of the lymph nodes in that region increase. This
causes swelling of the lymph nodes. Sometimes, the swollen
lymph nodes cause pain.
• Most common cause of swollen lymph nodes is infection. Lymph
nodes situated near an infected area swell immediately. When the
body recovers from infection, the lymph nodes restore their
original size gradually, in one or two weeks.
CAUSES FOR LYMPH NODE
SWELLING
• Skin infection of arm causes swelling of lymph nodes in armpit.
• Tonsillitis or throat infection causes swelling of lymph nodes in
neck.
• Infection of genital organs or leg results in swelling of lymph
nodes in groin.
• Viral infections such as glandular fever which affect the whole
body cause swelling of lymph nodes in various parts of the body.
• Cancer in a particular region may spread into the nearby lymph
nodes causing the swelling.
Throat cancer may spread into lymph nodes in neck.
Lung cancer may spread into lymph nodes in chest.
Breast cancer may spread into lymph nodes in armpit.
Intestinal cancer may spread into lymph nodes in abdomen.
Lymphomas (cancer of lymphatic system) and leukemia cause
swelling of lymph nodes in many parts of the body.
LYMPHADENOPATHY
• It refers to lymph nodes that are abnormal in
Size
Number
Consistency
• Abnormalities may be localized or generalized
GENERALIZED REGIONAL
LYMPHADENOPATHY LYMPHADENOPATHY
it involves
It is defined as
enlargement of a
enlargement of
single node or
more than 2
multiple
noncontiguous
contiguous nodal
lymph node groups
regions
PATHOPHYSIOLOGY
Lymph node enlargement may occur via any of the following
mechanisms:
• Nodal cells may replicate in response to antigenic stimulation or
malignant transformation (e.g., lymphoma).
• Large number of reactive cells from outside node (e.g.,
neutrophils or metastatic cells) may enter node.
• Foreign material may be deposited into node by lipid-laden
histiocytes (e.g., lipid storage diseases).
• Vascular engorgement and oedema may occur secondary to local
cytokine release.
• Suppuration secondary to tissue necrosis (e.g., Mycobacterium
tuberculosis)
GENERALIZED LYMPHADENOPATHY
INFECTIONS
• VIRAL INFECTIONS
– Epstein-Barr Virus
– Herpes simplex
– Mumps
– Adenovirus
– HIV
• BACTERIAL INFECTIONS
– Group A streptococcus
– Mycobacteria: typical and atypical
– Anaerobic bacteria
– Diphtheria
• FUNGAL / PARASITIC INFECTIONS
– Candida
– Cryptococcus
– Histoplasmosis
– Toxoplasmosis
• METABOLIC
– Lipid storage diseases
– Endocrine disease :
Hyperthyroidism
• HYPERSENSITIVITY
– Rheumatoid Arthritis
– Mixed connective tissue
disease.
– Systemic lupus erythematous
– Drug hypersensitivity
• NEOPLASTIC
– Hodgkin’s disease
– non- Hodgkin’s lymphomas
– leukaemia
REGIONAL LYMPHADENOPATHY
PHYSICAL EXAMINATION OF
LYMPH NODES
INVESTIGATION AND TREATMENT
