Can be physiological due to
increased demand of the
thyroid hormone as in
puberty, or due to mali-
gnant disease which needs
urgent diagnosis and
treatment
causes
Simple (non-toxic) goitre
Simple hyperplastic goitre
Multinodular goitre
Neoplastic goitre
Malignant
Papillary
Follicular
Anaplastic
Lymphoma
Medullary
Benign
Adenoma
Autoimmune
Hashimoto's thyroidits
Inflammatory
de Quervain's thyroditis
Riedel's thyroiditis
Toxic goitre
Graves' disease
Toxic nodule
Toxic multinodular goitre
Later diagnosed with thyrotoxicosis
Graves' Disease
Definition
Graves disease is the
most common cause
of endogenous
hyperthyroidism.
Pathogenesis
Graves disease is an autoimmune disorder in which
a variety of antibodies may be present in the
serum, including antibodies to the:
Autoantibodies to the
TSH receptor are central
to disease pathogenesis
and they include:
Thyroid-stimulating immunoglobulin
Thyroid growth-stimulating immunoglobulins (TGIs)
TSH-binding inhibitor immunoglobulins (TBII)
TSH receptor
Thyroid peroxisomes
Thyroglobulin
Morphology
Diffusely hyperplastic
thyroid in a case of Graves
disease. The follicles are
lined by tall, columnar
epithelium. The crowded,
en- larged epithelial cells
pro- ject into the lumens of
the follicles. These cells
actively resorb the colloid
in the centers of the
follicles, resulting in the
scalloped appearance of
the edges of the colloid.
Hyperemic “juicy”
appearance. The gland is
usually smooth and soft,
and its capsule is intact.
Risk factors
occurs more often in
women, mostly 20-40
years old
Characterised by
a triad of
Thyrotoxicosis, caused by a diffusely
enlarged, hyperfunctional thyroid, is present
in all cases.
An infiltrative ophthalmopathy with resultant
exophthalmos is noted in as many as 40% of
patients.
A localized, infiltrative dermopathy
(sometimes designated pretibial myxedema) is
seen in a minority of cases.
Laboratory Findings
Elevated serum free T4 and T3
depressed serum TSH
radioactive iodine uptake is
increased
Because of ongoing
stimulation of the
thyroid follicles by
thyroid-stimulating
immunoglobulins
Treatment
1- Propranolol
2- Thiourea drugs (Antithyroid drugs)
3- Iodinated contrast agents
4- Radioactive iodine
5- Thyroid surgery
Laila finally required
Thyroidectomy
Indications
Developmental Thyroid Abnormalities
Hyperthyroidism
Thyroiditis
Thyroid Nodules
could be
either
Subtotal
thyroidectomy:
Bilateral
removal of >50%
of each lobe and
an
isthmusectomy
or
Total
thyroidectomy:
Complete removal
of both thyroid
lobes, isthmus,
and pyramidal
lobe