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Thyroid malignancies

Overview ANATOMY RUKMAN MECCA

Embryology
Thyroglossal duct - from the median bud of the pharyngeal arch Descends from the foramen caecum In close contact with or through the hyoid bone

Development-THYROID

PARATHYROIDS

PYRAMIDAL LOBE

ECTOPIC THYROID THYROID

Anatomy - size, position, extent


Normal gland weighs 20 - 25 g Lies against C5,6,7,T1 clasping upper trachea Each lobe 5 x 2.5 x 2.5 cm, extends from middle of thyroid cartilage to 4/5th tracheal ring Isthmus 1.2 x 1.2 cm, extends from 2nd to 3rd rings

Contd.

Surgical Anatomy
Right lobe,left lobe,isthmus Pyramidal lobe - may project upwards from isthmus /one of the lobes Levator glandulae thyroideae fibrous/fibro muscular band from body of hyoid to isthmus or pyramidal lobe

relations

Arterial supply
Superior thyroid artery 1st branch of ECA Inferior thyroid artery from thyrocervical trunk which also supplies parathyroids Thyroidea ima seen in 3%, arises from brachiocepalic trunk or directly from arch of aorta Accessory thyroid arteries from tracheal and esophageal arteries

Surgical anatomy

Lymphatic drainage
Extensive lymphatic network within the gland
Some lymph channels pass directly to deep cervical node Sub capsular plexus drains principally into juxtathyroid nodes (pre & parathyroidal) and from there to the deep cervical and mediastinal nodes

Nerves in relation to thyroid


Recurrent laryngeal N branch of vagus, - runs in the tracheo-esophageal groove - closely related to inferior thyroid artery - supplies all intrinsic muscles of larynx except cricothyroid, - sensory to infraglottic larynx External branch of superior laryngeal N - related to sup.thyroid artery - supplies cricothyroid muscle

Histology
Functioning unit lobule Supplied by single arteriole Consists of 24-40 follicles,lined by cuboidal epithelium,contains colloid in which thyroglobulin is stored Parafollicular C cells lie between the follicles

CLASSIFICATION OF THYROID TUMOURS


BENIGN FOLLICULAR ADENOMA MALIGNANT PRIMARY:FOLLICULAR EPITHELIUMDIFFERENTIATED PAPILLARY FOLLICULAR FOLLICULAR EPITHELIUMUNDIFFERENTIATED ANAPLASTIC PARAFOLLICULAR-MEDULLARY LYMPHOID-LYMPHOMA SECONDARY-METS LOCAL INFILTRATION

BENIGN TUMOURS
Solitary nodules Histology Wide excision-lobectomy

Etiology-malignant tumours
PAPILLARY-radiation -ret/PTC3,ret/PTC1 oncogene -hormone dependant-TSH FOLLICULAR-endemic goitre,MNG MEDULLARY-parafollicular C cells -MEN-ll -not TSH dependant

MALIGNANT LYMPHOMA Autoimmune thyroiditis-lymphocytic infiltration

references
Bailey and Loves short practice of surgery 25th Human embryology I.B.Singh 8th edition Human anatomy vol 3,4th editionB.D.Chaurasia

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