THYROID

Blodd Auupply
Brwnch of extonal
Supteior thyroid arBeny-> Cainotid artoy.
lnfuior Bramch af thyrocorvicol
thyooid axtery umx braich, 9
Subelavian antony.

Thyoordea imaa oteny > Occasiona/ branch

brachio cephalic
o aovta o r
antey.
Venous drtinage
drain into
Suporior thyvoid vein IJV
oMiddle thyroid vein draiinto TV
(Not dluwoy present)
Intorion thysoid vein an nto CV

Narves in relatior
Extwnal Lonyngeal Nv.*'Neah uppvr pee
Bromch ef supveio
Lay eaN
Lontol pitch' of voiw
1nnn votus cricothyzeid
0
makieb.
Kecwe nt Lonygeal Vv> o Close to LoaDÀ pole
o Lies iv, tracheo-2s0-
phapea g0Ove
Entor Loynx a he
Tw
hyooid
cto u

arilace and icaid

CoHouge,
 unilaterad
RLN
to
e Iiway
cod fausy *ioaskenugs
veal

to 1/L RLN
lrywry
(loCloswe ofRsp.
Gloie distss
apestwu p.distus
R: ubation/Fra
Tacheostom
ILN Hycid boru

LN 7STA(up. thyroid
ELN
axt)
Cicoid Cartilage
twLge CCA (Common arotid.
attou
Thyooico RLN
RtSubelovionk-
otfo Lt subclaviov Arto
8achioupha
e antoy
1nvior troid at
ILN1nttmal Lamymqeal Nv. (Eotas Laymx
thyoug u6nyoid membrcu

SLN-Supvior Lovuyg eal Ny bromhv4

Vagus d e d ILN

ito ELN
ELNExtørnal Laryng eo N.
Close to upppolk of tyrid
nnenvateS caicothroid musde

VN Vag wo nerve
J
Nv.
RLN Recuwrunt Laymgaad
Close to Loon "po
Lies in tracheoesophaqead qoae
Karathyroid Glands

Supoticr faratwpid Gand

oveleps t Phayng eal pouch)
1nferior Paratlynid Glamd
ovel ops ocmv 31 Phauyn-
geal pouch
Localiswtiow of Panaihyeid Glamds
a reoptraitive 99 TC Sestamibi Scamv best)
CTAm necw

Porapehativ Anavtomical LocatiowV-

Fresent in Post avapect
of thepoid obe
Iny Parathuy3cid glanvd.
Tua louls pel
Sup. Parathy2oid gland-
Jn the middpont
to
TO v Supehior
entry point gITA
Shap- Faltentd ovou
Colouw-Light braw to tamv
V y milar swR
to Oundin fa
(7acidotally gemoved-
cidneytay fill)
Plave it in/a
pNS 5NK artyaaid g.
FLOAT- Fat)
 THYROIDECTOMY
cqutve of Ligation of vessels
Middle Thyvoid vein >
supvri thyooid padicle
Int. Thyooid veiw
nf. Thynoid afey
ypes
Total Turoide ctomy
Rermoval of botw
obes and Is thmus
enu dor
Malignomt caue
bub toll Twoidectomy
Removal ofboth Lo e
and Isthmus except
4gm of tnpsoid tissue w
eacw pidé at lown pole
(equal tb Volume of pulp
of 's thumb) at
Tacheo esophageal qu
Aons f benigw
cauAL
ZNaah total thupyoidectomy:
Removal of botw Lobes ama
Isthmus ezcept voy mall
thssue of fhysoid & Lowo
pole to safeguand RLN and
Paratyraid Vblod aupply
Aone in, apillay Ca Hhfsoid
.
in young nividua
Hemitupoidectomy
Remo val o 6m lobo
amd evtive isthmud.

dont in eigw tomdi-

-
tion involving onu lobe.
17 HPE p r comes
to be malgnant

so ta Cmpletiov
Thyrcide ctom

3Lobectomy
Ramo val of onu
lobe involved
bunlg7 Usionv

Hwtly Dunnill eperadion

Removal af one lobe amd
Subtotal ov
sthmus t
Ppesite tob
Aont iv Nowtoxie MNG. ,
Whue onu Lobe u atf Acted mov

Isthmusectom
Its done iw advomced careinonmay
in Riedel's
O7 OCcasional
thupoiditis to tyaovt Aevw
Afvido due to taeheal
nan ow i71
 Taicks to diagnose clinically iv Long Case

STN (lityhgvoid nolule)

MN4 (Mlti Nodulha geite)

" 2iuae suoellimg

Featwrs f Hyptypoidism ;-Plpitedion
Exetional
1f these oht beathlessuss
- Chest p a w
Pesent, Sau
-Exussive sdrating.
Toxic Heatintolunanë

Fine tpemor
- WFLoss inspite of
in creaatd eppefite
Loase stoo
Amenoahoe
Featuurs of Hypetkyroidismv-Lethangy
-Woans
- Cold intolohame
-Wtgiv inpite of
decieaatd appetite
Constipatio

-Memohagia
- Excessive hair loss
podticalarly lat
eyebrd.

toxie
Nofeaturs f Hypesthyreidism > Say Nev

Regarding Eeog
Nen toxic STN Colloid nodule (M.c)
Carcinoma Thypold
Follicwlar ademomay
Thyrokd Cyt
Toxic STN Toxic adenomav

Nontoxie MNG; oloid nodulks

Chr. Thyriditis
Ca thypotd
Foliular adonomav
Toxic MNG Toxie adenovoy
iffusc to xie Goitae Gravns diseace
to Jodin
Kitfrae non toxie Goit :oIndemic goitre (dudefiaen
 Goitoe 7 featwus of .achimoto's Hupriditi
tash

Hypotkyoridismv -
Riedel's thyoädilkg
.

Thuy void Lymphoma

NVESTIGATIONS for Thyoid Swalhin

Thapoid Fumetiontast:
Seoumv TSH, T3 FT%
,

Serurv TSH (St

Inv. for STN)

TSH
Indicazs
TSH TSH
Recveared Eithe
neaaed
T3, 74 73,Ty 6
within Nomad T3, T
imit (wNL)
breught down
to wNL by
medicatiorts
Lmaging: oUSG neck
Canv diffventiate soli
d ystic conpanmt
of a no dule
demonstoaBe nov palpable hidden
Cav
nodule
C a n Comment ov neck nedes (LN)

Helps to do FNAC fmv selid Componat.

 CT SCaN neck urualy done iv
Ca thyroid

okadio active Thyrojd Scanv-

Materials uaed: I* (for Acveening purpos
99w TC
J13 (lor ablation thorap)
Eits
5- Pazrticle -Particle
Bw Trau
Thypoid
4iss
*Clasificationv o nodule based ov uptaw of
Kadioactive matvia
take up radioaztivily.
Cold Nodule; Bos not narmalthyrid
All is tauen up by
+ Stamds or
RadioactvI glanvd
10-20/ malignant
Wanm Nodule Taue up bame yadioactiviy
an,the rest of the gland.
Hot NoduleTanes up all the mdioactivilg
rist of the glane ib
am
psed

Only 4, maligmam

Nodul with discordam Scam

tot or maN on 99w Tc but
Cold orv 1 /23

OFDG-PET Scan :-To defect mícvometastasis

in body.
ont ofl Total Tharoidectrmy
Ca
welliell difoventtated
USG
Thynoid it RAI Scav USG
negative but e n v
neck is
:hycgbkuim lwelis y 2 ng ml

FNAC USG guided fow Solid poxt

Can'tdifferiate Follicula
adenoma fram tolliculat Carunoma

Hurthe cell adenova on

H the Call Catu no may,
Conve mede biopsy Usually Not dou due to -
Chaneu of Hge
Tajuzy o vitalstrut-
twis of necw
Only Vndreaftions,
ww
Ancuplastie la tyoid.
Riedel' thpaidihs
Tiyran Lypmphomav
Carcinoma Thy7oid
opillay Ca thuoid
Most commow
Best Aroqnosis
Commonv in 30to 40 years womev

adiatiow ezposwe to necn 6 ann importamt

Tis factor.

fotholagy tindings: Orphanannieeye nudei,

Psammomabedy

Spread mainhy via kymphatts

Pnsetotiow: Painles tyrdo module,

Nac nodes
Latnal abomant thyrad
Nov palpable (occut primany
papillary Ca thyroiddc
endangea necw node due to
metastotic deposit.
 Serum 75H NL
(ually eutupai)
Confivmd by FNAC

Ttal Thuynecdomy
Central Necwdisechon
(f nodes at ntargeà)
0r
MRND
(tr biopsy Proverv LN)

Follrcular Ca Thyroid
Common in womanw anound So ys eld.
Long stcmding endemic goifve is,
1factor.
Pathology : Vascular am caprulz
invasion.
Spread: Haumatogenouo.
rismtation S7N
Long standing endamic
g r e a 7lant H{o
.

Ovapid increase in si2e.

M.C Site of
Metastasis: Plat bones
CPulsaHng seconciarie
FNAC : Folliculan povttonwv
CNo comment ov
CoTtcin omov or Adenomav
 Hemityvcidectomy

OR
Fro2ewSetiow biopy Wait for HPE veport

Concinomva Ca Adenama
Adenoma
o Complution St
Total Tuoidedomy StoP
Thpoidocton

Hurthia Call C

Variant f thuraid bu
follicnlan ca

differs iv llaoing vespects

B/L
usually mulifoca k
- Woes not tane up RA
metastasize
-

Move lisey to
to Local LN

Totod Thyoidectomy
20pbuy lochic cental

Nac dissection (No nodes

MRNDNodesovepositie
 Medullany Ca Thyroid
C colls of
Parafollicudlat
Avises from
thy7oid glannd.
IARCvetes Caletoniv

MENIA
Mouy o aussodiated 7
amd MEN IB Symdrome,

RET pvotooneogene s
positive,
in Stooma
Yathology : Amyloid
tresentatien: -Typoid sulelling
Necwnebes
- Aiadrhoe

MEN Tlat
yptoms
HTN/Fleshin
Headacht

Spocad 1Sot lumphatics amd

wiy hatmatogenos

Inv,-FNAC
Seum Caletoninw
Seruw CEA

I Phedhocmoutomav poesent
1t should be operat2d fivst.
Totod Tyridertomy a prophylactice
Centrar, neck disection

B/LMRND ifnodes are pesitive

 Anaplastic Ci Thyroid
-

Common in Eldorky womav

Spreadvi diech invasion
Prsentatiow -Ropiaky weasimg
Thy id Swelling
-Aysphagiav (kophagel mvobew
:

Rsp etisthes (thacheal tmvokemen

vHoarseness efvoie (RLN involemfs

Inv. to confjirw; Cove nezde biops

Anapla.stie Ca tyrotd

msectabe Resectabe
CMosty Comes iw this
Stas
Total Thy7bectoy
Isthmuoectony
Ithmusotomy
7o give vehi
dm thachcal
Compressian
Yolliotive chomo
thecapy Kodio-theraP
 hyroid Lymphoma
Commow iw Niddle aged womv
Hashimoto Thyroiditis is risk,factor.

Usualy o NHL s cell ype.

rsentatiow: thyneiè mass
-Corvical LN
-Compressi ve ymptons
-

B-Ay3ptoms of Lymphemau
Fevez
Night swoat.
Featwus of Hypothupáismv

Inv to confivw: -Core mudlo biopsu

EBRT +chemotherar
theatm
Swgical reskctiov to alleviate
Jaw obs trucive, Aymptoms.
 Follouw up Hotocol af la Thy zaidecfony
A For Well diforentiated Thypoid Ca. (TSH dpend
lapillany C Follicalae Ca
follicalar varuant, Hwthe
f tapillany Ca
cell ca
A RAI Assay
AI o detect and trrat metastasis.

herequisite; 3 TSH we has to be vaised.

60, T4 (talf Life is iwk) has to be stepp
6 wuxs befae Acav.
bat hao
T3 (PHalf Life 1dey) starte
do be toppe R w befose
Scam,

this 2 peio
Ns d.
Leco todine diek duing
Altornade way is > Cadnue hyraib spple-
TSH
ment k administo wombidant
ofav Sca

TOwou Aminstet ACeEring dosr of Latee.

how»s
C mEaauus uptane U24
this valu
Afls Total Thypeidectomy
Uptaney1 Administes thrapeutic
dase of l8
Thyroid hoomonu suppement:
pla.cument to suopress TSH lovel o preet
T4
Yewven
lovel f Arum TSHio-10
Tauget
 levels
B Senum Thyoglobueli (Y)

berum Tq Lovel should be(2ng/ml

when o T4 therapt
at
eumv Ta to be mearuu)
6 motw and then anm ualyg

Imaging
oUSG necw at cth mowt intetval fn firs
2 ears amd thev mnualy for
3 to 5 years.
hoe boày Scav
Afla b to 12 month of vemnant
ablation.

FD4
FDG-PET SCamv f rurv 1g 6
2 ng/.
EBRT nd CT :
EBRT Jr ivsectabk tocaly imvasive
mtastasis.
Ca and painyful bory
CT hao uch 1oole.
Doxorubiun t PacliBa xe/ may
be altomptrd.

B, For Medulhary (a tyroid:

Sevumy Calutonid easwu) at an
eyula intval,
USG necK
 *RET mutation Catrion > Prophylactomy
Thuyrdidectomuy dou.
MEN IJA Befooc 5 ys of age.
MENIB K 17 o

WORK UP OF STN
STN
Sevum TSH
Low TSH
Toxic Nodule) Novmal TSH
(Now toxic)
Radioisotope Scamv
USG nec
Hot nodule Cold nodule
Anityrgd
eDtationc ysic Solid
Radiactive Comple Si mple
ablatiow (IS)
Asprote FNAC
Reollection
Sungo Lobectomy Keaspivt sor ocovding
3time

Lobecto
 HASHIMOTo's THyROIDI TIS
M.C. laomadory diso de Thyroid
gland.
Autoiwmune. disozde
Etepathegencsis
Genetic aasociation THLA B8, DR3, DR5

Thyreid tissa
detcyd 6y
Cytotoxie T celil Arto Ab

Thyroglobuliu Thyoid TSH-R

Pthoxidae
MC)
lcraaud lodine intoxe
rugs -Amiodaronu
- Li
-IFN DO
His tology:
iffpwse imfiltadionu
am Plasma cells. of
amall
lynphooutas
Follicles aL
uneà by skamaa als.
 Common in woman (30 to 50 yos

Mid to mororade onlakgemet of Thyp ctd gan.

Vy perthyroidimy

Inv-Serum TSH
Audo Ab Psrive
FNAC

Thyraid hovmot vep/acmeni.

Sturaid Therepy may á nptu.

Surgeay Sulktal thyscidectony

-

Indicafion:-lompsessive ayopron's
Cosme tie puposé

ubaute myrroiditis / - Buwr vauzn't/

Gpanubmateuswiralhyvoidths
Common in nwomarv (30 to 50 y)

Follaos upph map. tract infrctio

Viral etiology.

.T.0
 4 Phoses
1. Hypas
tuaidism (du to mleoae ofprefn.
tpoid hoomo nes.
destaoaye follicleo
V
2.
Euthyrcidiw (efovm stove
adual iy depluted)
3.
Hypothyreidismv (Prtamd
hov mene thyaid
txhaustes
4.
Euthyreidligm(duz to esclution)
F Sove tharcot
Painfl tenvdo diffuae thuprid
Selling
Fever+/-
n.o Sl0- ESR I00 mmhr
RAt upta ke is decw
FNAC aaed
multinucleated giant cell
Self limiting for lain NSAIDS
-

hednisdone is helbfl.

RIE DEL'S THYROIDITIS

Invasive fbrous tyroiditis.
Thyroid farunchymev eplaud by fibrous tissu

Etiology Autoimmunt
Associomon-Mediastinal and tropeitoneed
fibvosis
Poriovbital and ntro oxsbitad
ibrosis
- Sclaosing cholangitic

tdoman (30 th 50s

faunless thyoord glan
hordy, woody
Fxed to ubrounding tisse
Compessive Ayypitms
vtypothyvcidism
viypopozathpoialsn