Ppt on Thyroid Gland
-
Upload
robert-rosales -
Category
Documents
-
view
30 -
download
15
Transcript of Ppt on Thyroid Gland
![Page 1: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/1.jpg)
THYROID GLAND
![Page 2: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/2.jpg)
CONTENTS:• Thyroid gland
– Hypothyrodism– Hyperthyrodism– Goiter– Thyrodidtis– Tumors
![Page 3: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/3.jpg)
• This is the normal appearance of the thyroid gland on the anterior trachea of the neck..
![Page 4: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/4.jpg)
![Page 5: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/5.jpg)
Normal thyroid seen microscopically consists of follicles lined
by a cuboidal epithelium and filled with pink, homogenous colloid
![Page 6: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/6.jpg)
Hypothyroidism:
• Causes:– structural or functional– 95% are due to:
• Surgical or radiation ablation• Hashimoto’s thyroiditis• Primary idiopathic hypothyroidism
![Page 7: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/7.jpg)
Cretinism
• This is uncommon disease of childhood due to failure of thyroid to synthesize thyroid hormones hypothyroidism
![Page 8: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/8.jpg)
Myxedma, CretenismMyxedma, Cretenism
![Page 9: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/9.jpg)
• Neurologic & myxedematous patterns • Clinically:
– mental retardation– growth retardation (short stature)– coarse facial features with dry skin and
protruding tongue– muscle weakness and umbilical hernia
![Page 10: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/10.jpg)
Myxedema• Hypothyroidism in adult.• - Clinically:
– appear insidiously & subtle– lethargy & weakness with slow speech– cold intolerance with cool & rough skin– menstrual problems & psychosis– cardiac changes: cardiac output, hypertrophy,
(myxedema heart), pericardial effusion– deposition of mucopolysaccharides in connective tissue– atherosclerosis ( cholesterol)
![Page 11: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/11.jpg)
Hyperthyroidism
• Excess thyroid hormone (Thyrotoxicosis)• Causes:
– primary diffuse toxic hyperplasia (Grave’s disease) > 95%
– toxic multinodular goiter– toxic adenoma– certain form of thyroiditis– secondary to pituitary or hypothalamic lesion
![Page 12: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/12.jpg)
• Clinical features:
• nervousness and emotional instability• menstrual changes• fine tremors of the hands• heat intolerance with warm skin and sweating• weight loss despite a good appetite
![Page 13: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/13.jpg)
• Eye changes: (exopthalmos, widened palpebral fissures, staring gaze)
• Cardiac changes: (tachycardia, palpitations, atrial fibrillation and thyrotoxic cardiomyopathy----- cardiac failure)
• skeletal muscle atrophy and fatty infiltration• lymphadenopathy• fatty change of the liver• Osteoporosis
![Page 14: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/14.jpg)
ThyrotoxicosisThyrotoxicosisUpper, thyrotoxicosis
Lower, after treatment
![Page 15: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/15.jpg)
Goiter
• Goiter simply means enlarged thyroid
![Page 16: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/16.jpg)
![Page 17: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/17.jpg)
Diffuse Goiter
• Characterized by diffuse symmetrical enlargement of thyroid (200 - 300 gm) with normal thyroid function.
• Hypofunction may occur early in the course .• Usually occurs in: Endemic areas (
iodine & goiterogens) or• Sporadic (physiological ,autoimmune ,
familial ).
![Page 18: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/18.jpg)
Multinodular Goiter
• Characterized by nodular asymmetrical enlargement of thyroid (up to 1000 gm)
• Slowly evolves from diffuse goiter.It can be toxic or non-toxic
![Page 19: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/19.jpg)
Solitary thyroid nodule
• Size (symptoms)• Possible hyperfunction• Usually colloid nodule >70%• Adenoma 20-30%• Carcinoma <5%• - Radioactive iodine (Hot & cold nodule)• FNA & biopsy• Thyroid function
![Page 20: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/20.jpg)
Solitary thyroid nodule
• Invisigations: • thyroid hormons: (T3,T4,TSH)• radiological examinations : * ultrasound (cystic/solid) * radioactive iodine (cold/hot)• Fine needle aspiration cytology
![Page 21: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/21.jpg)
GRAVE’S DISEASE• Primary Diffuse Toxic Hyperplasia• The most common cause of thyrotoxicosis• It is an autoimmune disease• Classically shows:
– 1-Exopthalmos (proptosis)– 2-Dermopathy (pretibial myxedema)– 3-Hyperthyroidism
• Common in 3♀ rd & 4th decade• ♀ : = 10 : 1♂• HLA – DR3 & Familial predisposition• Other autoimmune diseases may occur
![Page 22: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/22.jpg)
• Pathogenesis• B-cells secrete autoantibodies against
mainly TSH – Receptors (Abs. against microsomes, thyroglobulin, T3 & T4 can be seen)
![Page 23: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/23.jpg)
Morphology
• Gross: diffuse symmetrical enlargement of thyroid
![Page 24: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/24.jpg)
THYROIDITIS
• Hashimoto’s thyroiditis• Subacute (granulomatous,DeQuervian)
thyroiditis• Chronic lymphocytic (painless) thyroiditis• Riedel’s fibrous thyroiditis
![Page 25: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/25.jpg)
Hashimoto’s thyroiditis
• This is an autoimmune most common type of thyroiditis characterized by symmetrical modesty enlarged thyroid responsible for most cases of primary goiterous hypothyroidism.
![Page 26: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/26.jpg)
Pathogenesis
• B cells autoantibodies against microsomes and thyroglobulin.
• Cell-mediated destruction of the gland • ♀ : = 10 : 1 middle-aged ♂• Higher incidence of autoimmune disease
![Page 27: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/27.jpg)
Clinical Course
• Euthyroid--- hypothyroid• Moderate goiter• Hashitoxicosis(hyperthyroidism) occasionally• 5% - B cell lymphoma or rarely papillary
carcinoma of thyroid
![Page 28: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/28.jpg)
THYROID TUMOURS
1-BENIGN: Follicular adenoma
2-MALIGNANT:• Carcinoma of thyroid
– Papillary carcinoma– Follicular carcinoma– Medullary carcinoma– Anablastic carcinoma –Lymphoma Others –
rare (sq. ca, sarcomas, metastasis)
![Page 29: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/29.jpg)
ADENOMA
• Always follicular adenoma• No papillary adenoma of thyroid.• Solitary & encapsulated.• No capsular invasion.• Histology: Follicles –> macro (colloid), micro (fetal), normal
size (simple), trabecular (embryonal).• Sometimes composed of Hürthl cells (oncocytic)
Hurthle cell adenoma.
![Page 30: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/30.jpg)
ADENOMA
![Page 31: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/31.jpg)
ADENOMA
![Page 32: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/32.jpg)
CARCINOMA OF THYROID
• Causes:– Ionizing radiation– Hashimoto’s thyroiditis– Grave’s disease?
![Page 33: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/33.jpg)
Papillary Carcinoma 60-70%
• The most common type• Young age 20-50y , F:M=3:1• Forming papillae and psammoma bodies• Cells typically show ground-glass appearance with clear
grooved nuclei “Orphan Annie” and intranuclear inclusion
• 50% at presentation Cervical LN metastasis• Haematogenous spread is rare (not common)
![Page 34: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/34.jpg)
• Follicular variant of papillary carcinoma : No papillary formation . The nuclei shows typical nuclear ground glass appearance of papilary crcinoma.
• Grow slowly with indolent course• Occult microscopic variant
![Page 35: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/35.jpg)
Papillary Carcinoma
![Page 36: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/36.jpg)
Follicular Carcinoma• Macroscopically often encapsulated similar to
adenoma • Histologically : composed of follicles
with no papillary formation and no groundglass nuclear changes.
• sometimes the cells are oncocytic (Hurthle cell carcinoma).
![Page 37: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/37.jpg)
Follicular Carcinoma• Haematogenous spread (lung, bone, liver. . )• Poorer in prognosis than papillary carcinoma.• Represent approximatly 15%• Most patients are >40y • TYPES: 1- minimally
invasive FC. 2- widely invasive FC.
![Page 38: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/38.jpg)
Medullary Carcinoma of thyroid <5%
• Derived from calcitonin – secreting C-cells• Characterized by formation of amyloid
material from calcitonin, surrounded by small to medium sized cells with round to spindle shaped nuclei forming sheets, nests or cords
![Page 39: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/39.jpg)
Medullary Carcinoma
amyloid
![Page 40: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/40.jpg)
Medullary Carcinoma
• It has slow but progressive growth • Both lymphatic and hematogenous
metastasis occurs• 10-20% are familial, multicenteric in young
age, associated with MEN 2&3 • Immuno: +ve calcitonin• 80-90% sporadic, solitary, old age
![Page 41: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/41.jpg)
Anablastic carcinoma 5-10%
0ccurs in patient > 60 y• Poorly differentiated, highly malignant tumour usually forms
bulky necrotic mass often disseminate extensively through blood
• death occurs within 1-2 years (<10% survive for 10y)
• Histological variants:
• Giant cells, spindle cells(sarcomatoid), squamoid cells
![Page 42: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/42.jpg)
![Page 43: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/43.jpg)
![Page 44: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/44.jpg)
PARATHYROID GLAND
![Page 45: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/45.jpg)
PARATHYROID GLAND
![Page 46: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/46.jpg)
Hyperparathyroidism - Primary Hyperparathyroidism: Increase PTH due to parathyroid lesion
(Adenoma/hyperplasia) Hypercalcaemia
PTH Hypercalcaemia :– osteoclast to mobilize Ca++ from bone– Ca++ reabsorption in the kidney– Ca++ absorption in Git .through vit .D.– excretion of phosphate in urine .
• Part of MEN I & II• F : M = 3 : 1 > 40y
![Page 47: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/47.jpg)
Clinical features
• Asymptomatic (lethargy&weakness)• Bone pain (osteomalacia, osteoporosis & osteitis
fibrosa cystica/brown tumor)• Renal stones (nephrolithiasis)• Nephrocalcinosis• Metastatic calcification (blood vessels, soft tissue & &
joints)• Abdominal pain (peptic ulcer,pancreatitis) and mental
change
![Page 48: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/48.jpg)
Parathyroid adenoma
adenoma
normal
![Page 49: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/49.jpg)
Adenoma & Hyperplasia In adenoma one gland, Hyperplasia >one gland
• Frozen section (intraoperative consultation) required to confirm presence of parathyroid tissue.
Carcinoma of parathyroid: * Rare – Invasion and metastasis– Bands of collagen in the stroma– High mitotic figures.
![Page 50: Ppt on Thyroid Gland](https://reader034.fdocuments.in/reader034/viewer/2022051006/577cc0a51a28aba71190ad5e/html5/thumbnails/50.jpg)
Reporters:Jinky G. GomezMay Garcia P T C Sec B7:30-9:30amChild & Development