45 Years old Female patient complaining of severe pain in the neck swelling for one week. pain radiating to the ear. Swelling of her neck started 2 years ago. Fine Niddle Aspiration show cancer cells of thyroid tissue. Operation will done today morning.
Clinical pictures:
Local pictures:
1. moderate, regular diffuse thyroid enlargement.
2. soft consistency,
3. Smooth surface,
4. Evidence of high vascularity like systolic expansaile pulsation and thril, bruit maxium at upper poles, and
5. pain radiated or not to ear pathogmonic for cancer, and
6. Up and down with deglutition or not.
Systemic pictures:
1. Intolerance to hot weather,
2. Insomnia,
3. Exophthalmos; True or false,
4. Menorrhagia,
5. Loss of weight, and
6. Jaundice.
7. Diarrhea.
General Examination:
A. Vital signs,
B. Liver enlargement,
C. Upper and lower limbs ; warm hand and hyper reflexia.
Clinical detection of exophthalmos:
1. Exophthalmometer, 13 to 15 mm, more than it ; exophthalmos.
2. Ruler test; if touch the cornea,
3. Naffziger's method; eyeballs protrude beyond the plane of supercillary ridge.
These three are most important test.
4. Russell Frazer 's method ; depth of groove between upper orbital margin and eyeballs is shallow.
Etiology of true exophthalmos: deposition of fat and round cell infiltration in the retrobulbar tissues or may be autoimmune.
and false exophthalmos: retraction of upper eye lids due to contraction of levator palpabrea superior.
Picture is shown in the right side.
How to diagnose the diffuse toxic goitre and Toxic noduler goitre?
Both of them are diagnosed clinically based on and confirm by investigations.
For diffuse toxic goitre : most intolerance to hot weather where normal people can tolerate, insomnia, exophthalmos and less arrhythmia. And locally soft consistency, smooth surface,thril and bruit over upper pole of thyroid.
But in the toxic noduler goitre, usually no exophthalmos but more arrhythmia with other symptoms and locally firm consistency and noduler surface. Both are due to excessive amount of free thyroid hormones due to suppression of TSH. Information will be updated with time...............
Treatment:
1. Medical,
2. Radioactive Iodine and,
3. Surgical.
Indications for medical treatment :
- Diffuse toxic goiter
- Preoperative preparation
- Post operative recurrence
- Small gland and
- Refusal of surgery.
Medical treatment includes
- Carbimazole 10 mg three times per day, maximum dose at 60 mg per day, most used drug in Egypt .
It inhibits iodine binding to tyrosine.
- Propylthiouracil 100 mg t.d.s, same action plus prevents peripheral conversation of T4 into T3.
-Propanolol but not used in asthmetic patient, we used Atenolol And
- Iodides.
Clinical pictures:
Local pictures:
1. moderate, regular diffuse thyroid enlargement.
2. soft consistency,
3. Smooth surface,
4. Evidence of high vascularity like systolic expansaile pulsation and thril, bruit maxium at upper poles, and
5. pain radiated or not to ear pathogmonic for cancer, and
6. Up and down with deglutition or not.
Systemic pictures:
1. Intolerance to hot weather,
2. Insomnia,
3. Exophthalmos; True or false,
4. Menorrhagia,
5. Loss of weight, and
6. Jaundice.
7. Diarrhea.
General Examination:
A. Vital signs,
B. Liver enlargement,
C. Upper and lower limbs ; warm hand and hyper reflexia.
Clinical detection of exophthalmos:
1. Exophthalmometer, 13 to 15 mm, more than it ; exophthalmos.
2. Ruler test; if touch the cornea,
3. Naffziger's method; eyeballs protrude beyond the plane of supercillary ridge.
These three are most important test.
4. Russell Frazer 's method ; depth of groove between upper orbital margin and eyeballs is shallow.
Etiology of true exophthalmos: deposition of fat and round cell infiltration in the retrobulbar tissues or may be autoimmune.
and false exophthalmos: retraction of upper eye lids due to contraction of levator palpabrea superior.
Picture is shown in the right side.
How to diagnose the diffuse toxic goitre and Toxic noduler goitre?
Both of them are diagnosed clinically based on and confirm by investigations.
For diffuse toxic goitre : most intolerance to hot weather where normal people can tolerate, insomnia, exophthalmos and less arrhythmia. And locally soft consistency, smooth surface,thril and bruit over upper pole of thyroid.
But in the toxic noduler goitre, usually no exophthalmos but more arrhythmia with other symptoms and locally firm consistency and noduler surface. Both are due to excessive amount of free thyroid hormones due to suppression of TSH. Information will be updated with time...............
Treatment:
1. Medical,
2. Radioactive Iodine and,
3. Surgical.
Indications for medical treatment :
- Diffuse toxic goiter
- Preoperative preparation
- Post operative recurrence
- Small gland and
- Refusal of surgery.
Medical treatment includes
- Carbimazole 10 mg three times per day, maximum dose at 60 mg per day, most used drug in Egypt .
It inhibits iodine binding to tyrosine.
- Propylthiouracil 100 mg t.d.s, same action plus prevents peripheral conversation of T4 into T3.
-Propanolol but not used in asthmetic patient, we used Atenolol And
- Iodides.
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