INTRODUCTION...

1
1 ANATOMY.4
2 Ectopic thyroid tissue..5
3 Remnants of the thyroglossal duct may persist
and lead to the formation of.........5
4 SURGICAL ANATOMY...5
4.1 The important anatomical features with
surgical relevance are.......6
4.2 THE IMPORTANT CLOSE S URGICAL
RELATIONS OF THE THYROID GLAND......8
5 MICROSCOPIC STRUCTURE... 10
6 PHYSIOLOGY.....11
6.1 FORMATION AND SECRETION
OF THYROID HORMONES......12
7 HORMONES.....14
7.1 REGULATION OF THYROID SECRETION.....16
8 CLASSIFICATION OF GOITR......................................17
8.1 Classification by Hamilton Bailey and McNeill Love..17
8.2 . WHO Classification for endemic goitr...18
8.3 SIMPLIFIED W.H.O GOITRE CLASSIFICATION....18
9 ETIOLOGY...19
10 HEREDI.........19
11 PATHOGENESIS OF MULTINODULAR GOITRE...20
11.1 Endemic goiter... 20
11.2 Sporadic Goitre.......20
12 PATHOLOGY.....21
13 CLINICAL FEATURES...23
13.1 Growth........23

13.2 Function.24
13.3 Clinical Signs and Symptoms of
Multinodular Goiter....24
14 DIAGNOSTIC EVALUATION24
14.1 THYROID FUNCTION TESTS..25
14.2 Serum thyroid hormones25
14.3 Isotope scanning...27
14.4 Other tests of thyroid function..27
14.5 FINE NEEDLE ASPIRATION CYTOLOGY (FNAC).29
14.6 RADIOGRAPHY...30
14.7 ULTRASOUND.................31
14.8 CT AND MRI ......31
14.9 THYROID AUTO- ANTIBODIES ....31
14.10 INDIRECT LARYNGOSCOPY.32
14.11 CORE NEEDLE BIOPSY....32
15 TREATMENT......................33
15.1 MEDICAL TREATMENT...33
15.1.1 Levothyroxin suppression therapy..................33
15.1.2 Antithyroid drug therapy ....34
15.2 Radioiodi ne therapy and toxic multinodular goiter..34
15.3 Alcohol sclerotherapy.35
15.4 Radioiodine therapy and nontoxic multinodular goiter36
16 SURGERY...36
16.1 Argument for routine removal of nodular goiter36
16.2 Argument against removal of nodular goit re...37
16.3 MANAGEMENT OF CASE OF
MULTINODULAR GOITRE...38
16.4 SURGERY OF THE THYROID GLAND38
16.5 Subtotal Thyroidectomy...42

16.6 Near total thyroidectomy . Total Thyroidectomy42

16.7 Operation Steps in Surgery..43
16.8 SUBTOTAL THYROIDECTOMY.44
16.8.1 Skin Incision and Raising the Flaps..44
16.8.2 Exposure of the thyroid gland...45
16.9 Thyroid Dissection...45
16.10 Excision of the Gland.....46
16.11 HEMITHYROID ECTOMY.......46
16.12 TOTAL THYROIDECTOMY........47
16.13 NEAR TOTAL THYROIDECTOMY...48
16.14 TREATMENT OF RETROSTERNAL GOITRE...48
16.15 TREATMENT OF TOXIC
MULTINODULAR GOITRE IN PREGNANCY......49
17 POST OPERATIVE COMPLICATIONS...50
17.1 Haemorrhage....50
17.2 Respirat ory obstruction..50
17.3 Recurrent laryngeal nerve paralysis.51
17.4 Tracheomalacia ..52
17.5 External laryngeal nerve injury.............52
17.6 Thyroid insufficiency.....53
17.7 Parathyroid insufficiency...53
17.8 Thyrotoxic crisis (Thyroid storm) .......53
17.9Wound infection.54
17.10Stitch granuloma....54
17.11 Hypertrophic or Keloid Scar....54
17.12Recurrent thyrotoxicosis ...54
17.13 Progressive or malignant Exophthalmos ..55
17.14 Tetany.....55
18 Case Report..56

18.1 Discussion.........56
19 REFERENCES.......................59