Diseases Of Thyroid And Parathyroid Glands Question And Answers

Diseases Of Thyroid And Parathyroid Glands Important Notes

Hyperthyroidism And Hypothyroidism
Goitre
- It is the enlargement of the thyroid gland irrespective of its cause
- Goitre Classification
  - Simple goitre
    - Diffuse hyperplastic goitre
    - Nodular goitre
    - Colloid goitre
  - Toxic goitre
    - Diffuse toxic goitre
    - Toxic nodular goitre
    - Toxic nodule
  - Neoplastic goitre
    - Benign tumours
    - Malignant tumours
  - Thyroiditis
    - Autoimmune
    - Subacute
    - Reidel’s thyroiditis
  - Other rare causes
- Goitre Treatment
  - Addition of iodide
  - Discontinuation of offending drug
  - Administration of thyroxin
  - Surgical treatment for cosmetic purposes
Retrosternal Goitre
- Mainly derived from the lower pole of the multinodular goitre
- Retrosternal Goitre Classification
  - Substernal
  - Plunging
  - Intra-thoracic
- Retrosternal Goitre Treatment – resection
Thyrotoxicosis Or Toxic Goitre
- Thyrotoxicosis Or Toxic Goitre Causes
  - Grave’s disease
  - Toxic multinodular goitre
  - Toxic adenoma
  - Other rare causes
- Thyrotoxicosis Or Toxic Goitre Types
  - Primary toxic goitre / Grave’s diseases
  - Secondary toxic goiter
Thyroid Carcinoma

Diseases Of Thyroid And Parathyroid Glands Long Essays

Question 1. Describe clinical features, diagnosis and management of carcinoma of the thyroid.
Answer:

Thyroid Carcinoma is classified into four types:

Follicular Carcinoma:
- Follicular Carcinoma Clinical Features:
  - Occurs in old age
  - Common in females
  - An asymptomatic slow-enlarging thyroid nodule is present
  - Regional lymph nodes are involved
  - Pain is present
  - It invades adjacent structures
  - Distant metastasis occurs
- Follicular Carcinoma Treatment:
  - Low-grade carcinoma- treated by thyroid lobectomy
  - If regional lymph nodes are involved- Dissection of lymph nodes
  - Suppressive thyroid hormone therapy
  - Aggressive follicular carcinoma- Treated by near-total thyroidectomy and postoperative radiotherapy
Papillary Carcinoma
- Papillary Carcinoma Clinical Features:
  - Occurs at any age
  - Common in females
  - Slow growing tumour
  - Tends to become malignant
  - Asymptomatic nodules appear within the thyroid gland
  - Regional lymph nodes are enlarged
- Papillary Carcinoma Treatment:
  - Surgical excision
  - Near Total thyroidectomy
  - Suppressive dose of thyroid hormone post-operatively
Medullary Carcinoma:
- Arises from parafollicular C cells
- Medullary Carcinoma Types:
  - Sporadic
  - Familial variety
- Medullary Carcinoma Clinical Features:
  - Associated with mucocutaneous neuroma
  - It is present as a solid, hard, nodular tumour
- Medullary Carcinoma Treatment:
  - Near total thyroidectomy
  - Radical block dissection of lymph nodes
Anaplastic Carcinoma:
- Age- Over 50 years of age o Enlarged thyroid occurs
- Gland is fixed
- Consistency is hard to firm
  - Anaplastic Carcinoma Treatment:
    - Total thyroidectomy with modified neck dissection
    - Tracheostomy
    - External irradiation

Read And Learn More: General Surgery Question and Answers

Question 2. Describe clinical features, diagnosis and management of primary thyrotoxicosis.
Answer:

Primary Thyrotoxicosis Clinical Features:

Common in females a Loss of weight
Increased smooth muscle activity
Intolerance to heat
Fine tremors
Excitability
Hyperkinetic movements
Excessive sweating
Raised pulse rate
Diarrhoea
Polyuria
Hot moist palms
Systolic hypertension
Exophthalmos
Moebius sign- loss of convergence of eyeball
Stell Wag’s sign- infrequent blinking
Von Giraffe’s sign-lid lag sign

Primary Thyrotoxicosis Diagnosis:

Thyroid function tests- elevation of T₃, T₄ and decrease in TSH levels
Thyroid scan
Ultrasound- for the search of cysts

Primary Thyrotoxicosis Management:

To restore the patient to the euthyroid state
- Antithyroid drugs
  - Carbimazole-10 mg 6th hourly for 2-3 weeks
  - Propranolol-10-20 mg, two-three times a day
  - Lugol’s iodine-10-12 drops three times a day
- Potassium perchlorate- 20 mg three times a day
To reduce the functioning of thyroid mass
- Subtotal thyroidectomy
- Radio-iodine therapy
To minimize complications
- Proper anaesthetic measures
- Good post-operative care

Question 3. Discuss Grave’s disease in detail.
Answer:

Grave’s Disease: It is a diffuse goitre affecting the whole functioning thyroid tissue causing hypertrophy and hyperplasia due to abnormal thyroid stimulants

Grave’s Disease Etiology

It is a systemic autoimmune disease
It is hereditary
Another causative factor is emotional disturbances

Grave’s Disease Clinical Features: It consists of a classical triad

Grave’s Disease Goitre
- Characterised by an enlarged thyroid gland
- On palpation, the gland is smooth and irregular
- Bruit is heard
- Extreme vascularity is present.
Grave’s Disease Thyrotoxicosis
- Common in females
- Loss of weight
- Increased smooth muscle activity
- Intolerance to heat
- Fine tremors
- Excitability
- Hyperkinetic movements
- Excessive sweating
- Raised pulse rate
- Diarrhoea
- Polyuria
- Hot moist calms
- Systolic hypertension
Grave’s Disease Exophthalmos
- It means oro tarsi on of eyeball
- Spasm of the upper eyelid
- Proptosis with the widening of the palpebral fissure
- Supraorbital and infraorbital fissure
- Congestion and edema of the conjunctive
- Corneal ulceration

Diseases Of Thyroid And Parathyroid Glands Thyroid Simulating harmones

Grave’s Disease Investigations:

Thyroid function tests
- T₃ T₄ levels are high
- TSH levels are low
Presence of thyroid autoantibodies

Grave’s Disease Management

To restore the patient to the euthyroid state
- Antithyroid drugs
  - Carbimazole- 10 mg 6th hourly for 2-3 weeks
  - Propranolol-10-20 mg two-three times a day
  - Lugol s iodine- 10-12 drops three times a day
- Potassium perchlorate- 20 mg three times a day
To reduce the functioning of thyroid mass
- Subtotal thyroidectomy
- Radio-iodine therapy
To minimize complications
- Proper anaesthetic measures
- Good post-operative care

Question 4. Classify thyroid tumours. Discuss etiopathology.

Answer:

Thyroid Tumours Classification

Benign tumours
- Adenoma
  - Follicular adenoma
  - Papillary adenoma
Malignant tumours
- Follicular cell origin
  - Differentiated tumours
    - Papillary carcinoma
    - Follicular carcinoma
    - Mixed papillary and follicular carcinoma
  - Undifferentiated tumours
    - Anaplastic carcinoma
- Parafollicular cell origin
  - Medullary carcinoma
- Non-thyroid cell origin
  - Malignant lymphoma
  - Sarcoma
  - Metastatic carcinoma

Differentiated Thyroid Tumours:

Differentiated thyroid tumours are:
- Papillary carcinoma
- Follicular carcinoma

Thyroid Tumours Etiology:

Iodide deficiency
External irradiation
Ionizing radiation
Autoimmune thyroiditis

Question 5. Describe the etiopathology, clinical features and treatment of solitary nodules in the thyroid gland.
Answer:

Solitary Nodule In Thyroid Gland: It can be classified into benign and malignant nodules

Solitary Nodule In Thyroid Gland Etiopathogenesis:

Thyroiditis
Follicular adenoma
Carcinoma
Thyroid cyst
Colloid nodules

Solitary Nodule In Thyroid Gland Clinical Features:

Age-20-40 Years of age
Sex- common in females
Stridor
Tracheal deviation
Neck vein engorgement
Dyspnoea
Dysphagia
The solitary nodule is present

Solitary Nodule In Thyroid Gland Treatment:

Excision of solitary nodule along with a margin of normal thyroid tissue
If the nodule is present at the junction of the isthmus and lobe- hemithyroidectomy is done
In the presence of malignancy- immediate total thyroidectomy is done

Question 6. Discuss clinical features and treatment of multinodular goitre. Mention four complications of it.
Answer:

Multinodular Goitre: Multinodular goitre is the end-stage result of diffuse hyperplastic goitre

Multinodular Goitre Clinical Features:

Age- 40-60 years of age
Sex- common in females
Exophthalmos rarely occurs
The presence of long-standing swelling in front of the neck
Dyspnoea
Dysphagia
The gland is firm and irregular

Multinodular Goitre Treatment:

Total or near-total thyroidectomy
- It is widely used to
  - Avoid nerve injury
  - Avoid recurrence
- Subtotal thyroidectomy
  - In it, parts of the right and left lobes are removed along with the isthmus
  - It avoids right laryngeal nerve paralysis and hypothyroidism

Multinodular Goitre Complications:

Calcification
Sudden haemorrhage
Dyspnoea
Secondary thyrotoxicosis with CVS involvement- called Plummer’s disease
Development of follicular carcinoma

Question 8. Discuss clinical features and management of toxic goitre.

Answer:

Toxic Goitre Or Thyrotoxicosis: It refers to an accumulation of clinical manifestations which are due to excess secretion of acute thyroid hormones.

Toxic Goitre Or Thyrotoxicosis Causes:

Grave’s disease
Toxic multinodular goitre
Toxic adenoma
The early stage of thyroiditis
Neonatal thyrotoxicosis
Iatrogenic hyperthyroidism

Toxic Goitre Or Thyrotoxicosis Types:

Primary toxic goitre- Grave’s disease
Secondary toxic goitre

Toxic Goitre Or Thyrotoxicosis Clinical Features:

Primary Toxic Goitre
- It consists of a classical triad
  - Goitre
    - Characterised by an enlarged thyroid gland
    - On palpation, the gland is smooth and irregular
    - Bruit is heard
    - Extreme vascularity is present
  - Thyrotoxicosis
    - Common in females
    - Loss of weight
    - Increased smooth muscle activity
    - Intolerance to heat
    - Fine tremors
    - Excitability
    - Hyperkinetic movements
    - Excessive sweating
    - Raised pulse rate
    - Diarrhoea
    - Polyuria
    - Hot moist palms
    - Systolic hypertension
- Exophthalmos
  - It means protrusion of the eyeball
  - Spasm of the upper eyelid
  - Proptosis with the widening of the palpebral fissure
  - Supraorbital and infraorbital swelling
  - Congestion and edema of the conjunctiva
  - Corneal ulceration
Secondary Toxic Goitre
- Toxic multinodular goitre
  - Age- 40-60 years of age
  - Sex- common in females
  - Exophthalmos rarely occurs
  - The presence of long-standing swelling in front of the neck
  - Dyspnoea
  - Dysphagia
  - The gland is firm and irregular
- Toxic nodule
  - Occurs at a young age
  - Females are commonly affected
  - Thyroid swelling occurs
  - Presence of hyperthyroidism
  - There is a sudden increase in the size of swelling due to necrosis and intraglandular haemorrhage

Toxic Goitre Or Thyrotoxicosis Treatment:

Toxic Multinodular Goitre
- To restore the patient to the euthyroid state
  - Antithyroid drugs
    - Carbimazole-10 mg 6th hourly for 2-3 weeks
    - Propranolol-10-20 mg, two-three times a day
    - Lugol’s iodine-10-12 drops three times a day
  - Potassium perchlorate- 20 mg three times a day
- To reduce the functioning of thyroid mass
  - Subtotal thyroidectomy
  - Radio-iodine therapy
- To minimize complications
  - Proper anaesthetic measures
  - Good post-operative care
Toxic Nodule
- Anti-thyroid drugs
- Radiotherapy
- Subtotal thyroidectomy

Question 9. What is toxic goitre? What are the differences between primary and secondary goitre? Outline the treatment of primary toxic goitre of the thyroid gland.
Answer:

Toxic Goitre Or Thyrotoxicosis: It refers to an accumulation of clinical manifestations which are due to an excess section of acute thyroid hormones.

Difference Between Primary and Secondary Goitre:

Diseases Of Thrroid And Parathyroid Glands Difference Between Primary And Secondary Goitre

Question 10. Define goitre. Classify various types of goitre.
Answer:

Goitre Definition: Goitre refers to as enlargement of the thyroid gland irrespective of the cause

Goitre Classification

Simple Goitre
- Diffuse hyperplastic goitre
- Nodular goitre
- Colloid goitre
Toxic Goitre
- Diffuse toxic goitre
- Toxic nodular goitre
- Toxic nodule
Neoplastic Goitre
- Benign tumours
- Malignant tumours
Thyroiditis
- Autoimmune thyroiditis
- Subacute thyroiditis
- Reidel’s thyroiditis
Other Rare Causes

Diseases Of Thyroid And Parathyroid Glands Short Essays

Question 1. Hypocalcaemia Or Tetany
Answer:

Hypocalcaemia Or Tetany

Hypocalcaemia is defined as the presence of low calcium levels in the blood

Hypocalcaemia Or Tetany Causes:

Acute pancreatitis
Acute and chronic renal failure
Pancreatic and small intestinal fistulae
Hypoparathyroidism
Transient hypocalcaemia

Hypocalcaemia Or Tetany Clinical Features:

Numbness and tingling sensation in the circumoral region and the tips of the fingers and toes
Hyperactive tendon jerks
Muscle cramps
Carpopedal spasms
Positive Chvostek’s sign

Hypocalcaemia Or Tetany Treatment:

Intravenous administration of calcium gluconate or chloride
Oral administration of calcium lactate along with vitamin D

Question 2. Thyroid crisis Or Thyroid storm

Answer:

Thyroid Crisis Or Thyroid storm

It is a severe thyrotoxic reaction
It appears suddenly within 3-4 days after the operation
It is an acute exacerbation of hyperthyroidism

Thyroid Crisis Or Thyroid Storm Clinical Features:

Tachycardia
Fever
Restlessness
Delirium

Thyroid Crisis Or Thyroid storm Treatment:

Sedatives- morphine or pethidine
Control of hyperpyrexia- by use of ice bag, tepid sponging, hypothermic blanket
Oxygen administration
Potassium administration
Use of 100 mg cortisone
Lugol’s iodine is given intravenously
20-40 mg propranolol
Digitalis to treat atrial fibrillation

Question 3. Adenoma Thyroid
Answer:

Adenoma Thyroid

All benign tumours of the thyroid gland arise from glandular tissues and are called adenomas

Adenoma Thyroid Types:

Follicular adenoma
Papillary adenoma

Adenoma Thyroid Clinical Features:

Gradual swelling of the thyroid gland
Swelling is palpable
Bleeding in the tumour causes pain and a rapid increase in the size of the swelling

Adenoma Thyroid Investigations:

X-ray of the neck- for swelling

Adenoma Thyroid Treatment:

Excisional biopsy
Lobectomy and removal of adenoma with surrounding healthy tissue
Replacement doses of L-thyroxine

Question 4. Hashimoto’s thyroiditis
(or)
Autoimmune thyroiditis
Answer:

Autoimmune Thyroiditis

Autoimmune Thyroiditis is also called Hashimoto’s disease or lymphedema- noid goitre

Hashimoto’s Thyroiditis Etiology:

It is an autoimmune disease
Four antigens are detected
- Thyroid cell microsomes
- Thyroid cell nuclear component
- Thyroglobulin
- Nonthyroglobulin colloid

Hashimoto’s Thyroiditis Clinical Features:

Females are commonly affected the Onset is insidious
Thyroid enlargement with slight pain
Tenderness in the region of the thyroid
Mild hyperthyroidism
Shortness of breath
Fatigue
Increase in weight
Thyroid gland examination
- Diffuse swelling
  - Nodular
  - Firm or rubbery in consistency
Increased incidence of rheumatoid arthritis, hemo- Iyitc anaemia, myasthenia gravis and pernicious anaemia

Hashimoto’s Thyroiditis Treatment: Surgical excision

Question 5. Solitary nodule of thyroid
(or)
Thyroid nodule
Answer:

Solitary Nodule Of Thyroid

Solitary Nodule Of Thyroid can be classified into benign and malignant nodules

Thyroid Nodule Etiopathogenesis:

Thyroiditis
Follicular adenoma
Carcinoma
Thyroid cyst
Colloid nodules

Thyroid Nodule Clinical Features:

Age- 20-40 Years of age
Sex- common in females
Stridor
Tracheal deviation
Neck vein engorgement
Dyspnoea
Dysphagia
The solitary nodule is present

Thyroid Nodule Treatment:

Excision of solitary nodule along with a margin of normal thyroid tissue
If the nodule is present at the junction of the isthmus and lobe- hemithyroidectomy is done
In the presence of malignancy- immediate total thyroidectomy is done

Question 6. Retrosternal Goitre
Answer:

Retrosternal Goitre

Retrosternal goitre is derived from the lower pole of the multinodular goitre

Retrosternal Goitre Clinical Features:

Usually asymptomatic
Symptoms occur as obstruction
- Obstruction of trachea- Dyspnoea
- Obstruction of the oesophagus- Dysphagia
- Obstruction to the major veins in the thorax- Engorgement of neck veins

Retrosternal Goitre Investigations:

Thyroid scan
Thyroid function tests
Barium swallow
Chest X-ray

Retrosternal Goitre Treatment: Resection of retrosternal goitre

Question 7. Gasification of goitre.
Answer:

Gasification Of Goitre

Goitre refers to the enlargement of the thyroid gland irrespective of the cause

Gasification Of Goitre Classification:

Simple Goitre
- Diffuse hyperplastic goitre
- Nodular goitre
- Colloid goitre
Toxic Goitre
- Diffuse toxic goitre
- Toxic nodular goitre
- Toxic nodule
Neoplastic Goitre
- Benign tumours
- Malignant tumours
Thyroiditis
- Autoimmune thyroiditis
- Subacute thyroiditis
- Reidel’s thyroiditis
Other Rare Causes

Question 8. Thyroglossal Fistula
Answer:

Thyroglossal Fistula

A Thyroglossal cyst may rupture unexpectedly resulting in a draining sinus known as a Thyroglossal fistula
It can develop when the removal of the cyst has not been fully completed
It is usually noticed when bleeding in the neck occurs causing swelling and fluid ejection around the original wound of removal
It is lined by columnar epithelium

Thyroglossal Fistula Types

Congenital
- Thyroglossal fistula is a disorder of the Thyroglossal duct which develops from the thyroid primordium in the floor of the primitive pharynx at the site of foramen caecum
- If involution of the Thyroglossal duct is incomplete, the Thyroglossal fistula may develop
Acquired
- Incomplete removal of Thyroglossal cyst
- Rupture of Thyroglossal cyst

Thyroglossal Fistula Treatment: Sistrunk operation

Diseases Of Thyroid And Parathyroid Glands Short Answers

Question 1. TSH
Answer:

TSH

Thyroid stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland
It regulates the endocrine function of the thyroid gland
It controls the rate of secretion of thyroxine and triiodothyronine by the thyroid gland
It controls the rates of most intracellular chemical reactions in the body
TSH secretion is regulated via a negative feedback loop by T4 and T3, when their levels are low, the production of TSH is increased
When their levels are high, TSH production is decreased

Question 2. Goitre
Answer:

Goitre

Goitre refers to the enlargement of the thyroid gland

Goitre Clinical Features:

Hoarseness of voice
Coughing
Dysphagia
Dyspnoea

GoitreTreatment:

Use of antithyroid drugs
Use of Levothyroxine in euthyroid patients
Thyroidectomy

Question 3. Thyroid scan I131
Answer:

Thyroid Scan I131

I131 is obtained at 24 hours

Thyroid Scan I131 Indications:

When a solitary nodule is palpated
In retrosternal goitre
In ectopic thyroid tissue
In toxic nodular goitre

Thyroid Scan I131 Uses:

To distinguish functioning and non-functioning thyroid nodules
To diagnose pathology of the thyroid gland
To assess the nature of the nodule
Detect areas of abnormality
Determine the spread of thyroid cancer
Evaluate changes in the gland

Question 4. Exophthalmos
Answer:

Exophthalmos

It means protrusion of the eyeball
Spasm of the upper eyelid
Proptosis with the widening of the palpebral fissure
Supraorbital and infraorbital swelling
Congestion and edema of the conjunctiva
Corneal ulceration

Question 5. Hoarseness of voice
Answer:

Hoarseness Of Voice

Hoarseness Of Voice is an abnormal change in voice

Hoarseness Of Voice Causes:

Acid reflux
Smoking
Alcohol
Screaming
Allergies
Inhaling toxic substances
Coughing
Polyps on the vocal cords
Throat, thyroid or lung cancer
Damage to the throat
Aortic aneurysm

Hoarseness Of Voice Treatment:

Rest your voice for a few days
Avoid talking and shouting B Drink plenty of fluids
Take hot showers and Use lozenges Avoid smoking
Eliminate allergens

Question 6. Causes of dyspnoea in goitre
Answer:

Causes Of Dyspnoea In Goitre

Pressure due to enlarged thyroid gland
Formation of haematoma
Tracheomalacia
Bilateral recurrent laryngeal nerve injury
Hypocalcaemia

Question 7. Metastasis in papillary carcinoma of the thyroid.
Answer:

Metastasis In Papillary Carcinoma Of The Thyroid

Papillary carcinoma of the thyroid invades the lymphatic’s and spreads to other sites
Vascular invasion is rare
If occurs, it occurs through the lungs and bones
Direct extension into soft tissues of the neck occurs in approx. 25% of cases

Question 8. Post-operative complications of thyroid surgery.
Answer:

Thyroid Surgery Complications:

Minor Complications
- Seromas
- Poor scar formation
Rare Complications
- Damage to the sympathetic trunk
Major Complications
- Bleeding
- Injury to recurrent laryngeal nerve
- Hypoparathyroidism
- Thyrotoxic storm
- Injury to the superior laryngeal nerve
- Infection

Question 9. Thyroglossal cyst
Answer:

Thyroglossal Cyst: It is a cystic swelling developed in the remnant of the thyroglossal tract

Thyroglossal Cyst Etiology: Develops from the ventral portion of the endoderm between the first and second branchial arch

Thyroglossal Cyst Clinical Features:

Age- common between 15-30 years of age n Sex- common in women h Pain in cyst
Size: 0.5 cm to 5 cm in diameter
Shape: spherical or oval
Cysfbecomes tender
It may develop anywhere along the thyroglossal tract
Firm or hard in consistency
Cyst moves with deglutition

Thyroglossal Cyst Management: Excision of the cyst

Question 10. Plunging goitre
Answer:

Plunging Goitre

Plunging goitre is also called wandering goitre or diving goitre
Plunging goitre is freely movable above or below the sternal notch
Plunging goitre is usually not palpable
Plunging goitre is palpable during coughing, and sneezing due to increased intrathoracic pressure

Question 11. Hypercalcaemia
Answer:

Hypercalcaemia

Hypercalcaemia is a condition in which the calcium level in the blood is above normal

Hypercalcaemia Causes:

Overactive parathyroid glands
Cancer
Calcium and vitamin D supplements

Hypercalcaemia Clinical features

Excessive thirst and frequent urination
Nausea, vomiting, constipation
Bone pain. Muscular weakness
Confusion, lethargy, depression
Palpitation, cardiac arrhythmia

Question 12. Gynaecomastia
Answer:

Gynaecomastia

Gynaecomastia is an endocrine disorder in which a noncancerous increase in size of male breast tissue occurs

Gynaecomastia Causes:

Altered ratio of Estrogen to androgen
Diseases like liver disease, kidney failure, low testosterone
Certain medications

Gynaecomastia Clinical features

Male breast enlargement with soft, compressible and mobile subcutaneous chest tissue
Enlargement may occur on one side or both
Asymmetry of chest tissue occurs

Diseases Of Thyroid And Parathyroid Glands Viva Voce

Among simple goitre, nodular goitre is more prone to malignant transformation

Diseases Of Thyroid And Parathyroid Glands Important Notes

Diseases Of Thyroid And Parathyroid Glands Long Essays

Diseases Of Thyroid And Parathyroid Glands Short Essays

Diseases Of Thyroid And Parathyroid Glands Short Answers

Diseases Of Thyroid And Parathyroid Glands Viva Voce

Leave a Comment Cancel reply