Laila was Losing Weight

ANATOMY OF THE NECK
1. IMPORTANT MIDLINE SURFACE LANDMARKS
  1. 1- HYOID BONE: U-shaped with a body, lesser and greater horns. Level of C3 vertebra. Moves during swallowing.
    1. 2-LARYNGEAL PROMINENCE: Formed by the thyroid cartilage. More prominent in the male & rises with swallowing Lies at the level of the C4 & 5 vertebrae. It rises during swallowing.
      1. 3- CRICOID CARTILAGE: Level of C6 vertebra.
  2. triangle
    1. Anterior triangle
      1. Anterior: Median line Posterior: Sterno cleidomastoid Base: Mandible + Line from angle to mastoid Apex: Suprasternal notch
    2. Posterior triangle
      1. Anteriorly: Sternomastoid Posteriorly: Trapezius Apex: Meeting between trapezius & sternomastoid at the back of the skull. Base: Middle third of the clavicle, between the attachment of sternomastoid and trapezius.
2. Ddx of swollen neck
  1. <20 years Congenital lesions Inflammatory Chronic infections Malignant lesions
    1. 20-40 years Salivary gland pathology Thyroid pathology Chronic infections
      1. >40 years Primary malignant tumor Metastatic lymph node
3. Histology of the thyroid gland
  1. Gland covered by capsule. Septa extends into the gland dividing it into lobules Each lobule – made of an aggregation of follicles. Each follicle is spherical in structure Follicular wall is lined with a single layer of cuboidal cells that secrete into the interior of the follicles. Each follicle is filled with pink-staining proteinaceous material called colloid. EM shows follicular cells with apical microvilli and many secretory granules. Between thyroid follicles are parafollicular or C cells, which secrete calcitonin
hyperthyroidisum
1. History Taking
  1. Past medical history: Expectorants, Amiodarone, Thiocyanates and Perchlorites, iodinated contrast dyes. Health food supplements containing seaweed or thyroid gland extracts. Contain large amounts of iodine that can induce thyrotoxicosis in a patient with thyroid autonomy
    1. Past family history: Autoimmune disease Thyroid disease Emigration from iodine-deficient parts of the world (Diet!) Iodine-deficient diet: can lead to hypothyroidism or cretinism. Cabbage, turpins and coli-flower
      1. Conditions that affect the thyroid function: Low T3 syndrome Liver cirrhosis Nephrotic syndrome Pregnancy
2. Investigations
  1. Blood tests (Thyroid function tests)
    1. Tests that establish whether there is thyroid dysfunction (TSH,T4 and T3 measurements)
    2. Tests to know the cause of thyroid dysfunction (thyroid auto-antibody and serum thyroglobulin measurements, thyroid enzyme activities, biopsy of the thyroid, ultrasound and isotopic thyroid scanning )
  2. Non Blood investigations
    1. RADIOACTIVE IODINE UPTAKE
      1. RADIOACTIVE IODINE UPTAKE Because T4 contains much iodine, the thyroid gland must pull a large amount of iodine out from the blood stream in order for the gland to make an appropriate amount of T4. The thyroid has developed a very active mechanism for doing this
  3. Cholesterol test
    1. Your doctor may need to check your cholesterol levels. Low cholesterol can be a sign of an elevated metabolic rate, in which your body is burning through cholesterol quickly.
  4. Ultrasound test
    1. Ultrasounds can measure the size of the entire thyroid gland, as well as any masses within it. Doctors can also use ultrasounds to determine if a mass is solid or cystic
3. causes
  1. excess iodine, a key ingredient in T4 and T3 thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland tumors of the ovaries or testes benign tumors of the thyroid or pituitary gland large amounts of tetraiodothyronine taken through dietary supplements or
4. Signs and symptoms
  1. increased appetite nervousness restlessness inability to concentrate weakness irregular heartbeat difficulty sleeping fine, brittle hair itching hair loss nausea and vomiting breast development in men
  2. The following symptoms require immediate medical attention:
    1. dizziness shortness of breath loss of consciousness fast, irregular heart rate
5. diagnose
  1. weight loss rapid pulse elevated blood pressure protruding eyes enlarged thyroid gland
6. treat
  1. Medication
    1. Antithyroid medications, such as methimazole (Tapazole), stop the thyroid from making hormones. They are a common treatment.
  2. Radioactive iodine
    1. Common side effects include dry mouth, dry eyes, sore throat, and changes in taste. Precautions may need to be taken for a short time after treatment to prevent radiation spread to others
  3. Surgery
    1. A section or all of your thyroid gland may be surgically removed. You will then have to take thyroid hormone supplements to prevent hypothyroidism, which occurs when you have an underactive thyroid that secretes too little hormone. Also, beta-blockers such as propranolol can help control your rapid pulse, sweating, anxiety, and high blood pressure. Most people respond well to this treatment.
      1. Thyroidectomy
        Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck
7. Complications
  1. Injury to the External Laryngeal Nerve: Paralyzed cricothyroid muscle. Injury to the Recurrent Laryngeal Nerve: Injury to the cervical sympathetic trunk or a sympathetic ganglion /
8. Epidemiology
  1. Hyperthyroidism is more common in women than men (5:1 ratio). the prevalence of overt hyperthyroidism among persons age 12 years and older was 0.5% , Hyperthyroidism is also more common in smokers. Graves' disease is seen most often in younger women, while toxic nodular goiter is more common in older women. In one prospective cohort study of adult women, the overall incidence of Graves' disease was 4.6 per 1000 during 10 years of observation
9. Follow up
  1. Reduce medication after 4-6 weeks, the patient should be totally off anti-thyroid medication in 12-18 months Check thyroid function tests every 4-6 weeks Monitor closely for remission

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	Created by shaikha alzaabi about 7 years ago