Updates In Thyroid Diseases

Abd Hamid Mat Sain Consultant Surgeon

Columbia Hospital Seremban

Thyroid vs Goitre(Thyroid Swelling)

Who treats Thyroid diseases?

• Physicians

• Endocrinologists

• Surgeons

• Head and Neck Surgeons

• Oncologists

• General Practitioners/Family Physicians

Symptoms and Signs of Thyroid Diseases

• (Anatomy)Structural effects/Local

• (Physiology)Hormonal effects/Systemic

• Systemic Structural effects

Clinical diagnosis of Thyroid Diseases

• Hypothyroidism/Euthyroidism(Non-toxic)

• Hyperthyroidism(Toxic)

• Smooth generalised Goitre

• Multinodular Goitre

• Solitary Nodule/(Goitre)-Left or Right

Goitre Work up• Ultrasound

• (CT scan)

• Thyroid Function Tests

• Thyroid Antibodies

• Fine Needle Aspiration Cytology

• (Radio-isotope)

Pathological Diagnosis of Thyroid diseases

• Atrophy

• Thyroiditis

• Cyst

• Colloid goitre

• Adenoma

• Carcinoma

Table 1

Solitary Nodule Multi-Nodular

Male Very High Low

Female High Very Low

Risk of Thyroid Cancers in Nodular Goitres

Medical Rx of Thyroid Diseases

• Hyperthyroidism

• beta blocker

• Hypothyroidism

Indications for Thyroidectomy

• Cosmesis

• Compressive Symptoms

• Diagnostic

• Benign Neoplasm

• Cancer

• (Failed Medical Treatment)

Thyroidectomies• Lobectomy

• Total Thyroidectomy (Near)

• Completion Thyroidectomy

• Radical Thyroidectomy

• (Partial/Subtotal Thyroidectomy)

Complications of Thyroidectomy

• Bleeding

• Numbness & Cramps ; Ca

• Hoarseness

• Infections

Post Thyroidectomy-Long term Sequelae

• Hypothyroidism—>Euthyroid

• Recurrence

• Thyroiditis

New Trends

• Endoscopic Thyroidectomy

• Local Anaesthesia

• Acupuncture Anaesthesia

Conclusions• Thyroid diseases are common

• Correct diagnosis based on clinical features and pathology types

• Primary Care and Specialists treat thyroid diseases

• Post thyroidectomy sequelae are common but serious complications are rare