From: Subject: Name of speciality Date: Thu, 5 Oct 2006 10:19:27 +0530 MIME-Version: 1.0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\WINNT\Profiles\Administrator\Desktop\1sep\surgery\thyroidtumour.htm X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Name of = speciality

Name of speciality           =20 :           =20 General Surgery

Name of case=20            =20 :           =20 Thyroid Neoplasm

Name of expert :           =20 Dr. Aravindal Nair

Name of Hospital           =20 :           =20 Christian Medical = College,=20 Velllore

 

 

History

-       Duration = of swelling

-       Rapid = increase in size indicates malignancy

-       Increase = in size with fever and pain indicates haemorrhage

-       Family = history of thyroid swelling, family history to suggest=20 hypertension, hyperparathyroidism

-       History of = exposure to radiation

-       Endemic = area

-       = Goitrogenic drugs

-       Change in = voice, pressure symptoms

-       History to = suggest hypo or hyperthyroidism

 

Clinical = Examination

-       Pulse = Rate

-       Blood = pressure

-       Unilateral = / bilateral

-       Size, = shape, surface, consistency

-       Movement = on deglutition / protrusion of tongue

-       = Independent mobility off the treachea

-       Tracheal = position

-       Nodes

-       = Carotids

-       = Retrosternal extension =96 by percussion

 

Investigations

-       = Ultrasound

-       Ultrasound = guided FNAC

-       Isotope = scan for toxicity, thyroglossal cyst and for follow up=20 after malignancy(not for solitary nodule)

-       Thyroid = function tests if one suspects hypo or=20 hyperthyroidism

-       Xray = chest

-       Ultrasound = and CT for nodes in the neck and mediastinum

 

Differential diagnosis=20 for

a)      = Solitary thyroid nodule

-        =20 Dominant nodule of multinodular goiter

-        =20 Cyst

-        =20 Adenoma

-        =20 Carcinoma

-        =20 Focal thyroiditis

 

Non surgical = management

In thyrotoxicosis

-        =20 1-131 ablaion

In operable

-        =20 Carcinoma =96 external RT, 1-131 ablation

-        =20 Clear cyst aspiration alone is enough. If the cyst=20 reaccumulates, then hemithyroidectomy can be done

 

Surgical = management

-        =20 Unilateral thyroid swelling =96 hemithyroidectomy

-        =20 In malignant =96 total thyroidectomy + modified neck = dissection=20 on the side of the nodes

-        =20 In mdeullary carcinoma =96 Total thyroidectomy + = central=20 compartment clearance

-        =20 If nodes present, modified neck dissection

-        =20 Multinodular goiter =96 Subtotal thyroidectomy

-        =20 In malignancy

Differentiated =96 = total=20 thyroidecto my + 1-131 ablation.

Follicular=20 carcinoma with secondaries =96 total thyroidectomy followed by 1-131 = ablation