Exploring the vascular supply and nerves of the thyroid gland, anatomy and physiology of the thyroid gland, diagnosis and management of hyperthyroidism, Grave's disease, and multinodular goiters, detailed analysis of various thyroid disorders and their treatment options, and discussion on the timing of prophylactic thyroidectomy for different risk patients.
The vascular supply to the thyroid includes the superior thyroid artery, inferior thyroid artery, and the thyroid IMA artery, while the venous drainage includes the superior thyroid vein draining into the internal jugular vein and the inferior thyroid vein draining into the anominate vein.
The superior laryngeal nerve innervates the cricothyroid muscle, and damage to it can result in loss of projection and fatigue during speaking, whereas the recurrent laryngeal nerve, responsible for motor function of the vocal cords, can cause vocal cord paralysis if injured.
Deep dives
Vascular Supply to the Thyroid
The vascular supply to the thyroid includes the superior thyroid artery, inferior thyroid artery, and the thyroid IMA artery. The superior thyroid vein drains into the internal jugular vein, while the inferior thyroid vein drains into the anominate vein.
Nerves of the Thyroid
The superior laryngeal nerve innervates the cricothyroid muscle, and damage to it can result in loss of projection and fatigue during speaking. The recurrent laryngeal nerve, which loops around the anominate artery, is responsible for the motor function of the vocal cords. Injury to this nerve can cause vocal cord paralysis, and bilateral injury can obstruct the airway.
Thyroid Physiology and Pathology
Thyroid globulin, produced by follicular cells, helps in the synthesis of T3 and T4. Calcitonin, produced by C cells, lowers serum calcium levels. Thyroglossal duct cysts, which can be malignant, should be resected. Hyperthyroidism is characterized by low TSH and elevated T3 or T4 levels, and it can be medically treated with PTU or methimazole. Graves' disease can be diagnosed through radioactive iodine uptake or testing for antibodies against TSH receptors. For thyroid nodules, ultrasound is used to determine if an FNA is needed, and the Bethesda criteria are used to guide further evaluation. Thyroid lymphoma is diagnosed through FNA, and it has an excellent response to chemotherapy. Pappillary thyroid cancer is the most common malignancy, and its diagnosis includes FNA showing orphan ann bodies and anti-nuclear antibodies. Total thyroidectomy is the recommended management, along with lymph node dissection based on compartment involvement. Follicular thyroid cancer may require a diagnostic or therapeutic lobectomy, and medullary thyroid cancer originates from parafollicular C cells and requires total thyroidectomy with central neck dissection. Medullary thyroid cancer is also associated with MEN2A and MEN2B syndromes, which may require prophylactic thyroidectomy. Rapid-fire topics include diagnosing follicular thyroid cancer with a diagnostic lobectomy, managing thyroiditis with hormone replacement therapy and steroids, and evaluating thyroid nodules using ultrasound and FNA.
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