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Learning objectives To understand the development and anatomy of the • thyroid gland To know the physiology and investigation of thyroid • function Learning objectives To understand the development and anatomy of the • thyroid gland To know the physiology and ...

Malignant lymphoma In the past, many malignant lymphomas were diagnosed as small round-cell anaplastic carcinomas. Response to irradiation is dramatic ( Figure 55.27 ) and radical surgery is unnecessary Antoine Marfan , 1858–1942, paediatrician, University of ...

Malignant tumours The vast majority of primary malignancies are carcinomas derived from the follicular cells ( Table 55.6 ). Such tumours were thought of as di ff erentiated (papillary , follicular and Hürthle cell) and undi ff erentiated (anaplastic). However...

Medullary carcinoma These are tumours of the parafollicular (C cells) derived from the neural crest that are not unlike those of a carcinoid tumour ( Figure 55.26 ). High levels of serum calcitonin and carcinoembryonic antigen are produced. Calcitonin level...

NEOPLASMS OF THE THYROID Classification of thyroid neoplasms is presented in Table 55.6 and the relative incidence of malignancies in Table 55.7 . - - - TABLE 55.6 Classi /f_i cation of thyroid neoplasms. Benign Follicular adenoma Malignant Primary Follicular...

PHYSIOLOGY Thyroxine The hormones tri-iodothyronine (T ) and /l.sc -thyroxine (T 3 bound to thyroglobulin within the colloid. Synthesis within the thyroglobulin complex is controlled by several enzymes, in distinct steps: /uni25CF trapping of inorganic iodide...

Prognosis in differentiated thyroid carcinoma The prognosis in di ff erentiated thyroid cancers is generally excellent. In terms of survival, older patients, those with large tumours or those with extrathyroid extension or distant metas - tases have worse out...

SURGICAL ANATOMY The normal thyroid gland weighs 20–25 /uni00A0 g. The functioning unit is the lobule supplied by a single arteriole and consists of 24–40 follicles lined with cuboidal epithelium. The follicle contains colloid in which thyroglobulin is stored...

Serum thyroid hormones Serum thyroid-stimulating hormone TSH levels can be measured accurately down to very low serum concentrations with an immunochemiluminometric assay . - Interpretation of deranged TSH levels depends on knowledge of the T and T values. I...

Simple goitre Aetiology Simple goitre may develop as a result of stimulation of the thyroid gland by TSH, either as a result of inappropriate secre tion from a microadenoma in the anterior pituitary (which is rare) or in response to a chronically low level ...

Surgery for thyrotoxicosis Preoperative preparation Traditional preparation aims to make the patient biochemi - cally euthyroid at operation. Preparation is as an outpatient and only rarely is admission to hospital necessary on account of severe symptoms at p...

Surgical treatment for differentiated thyroid cancer This subject has many contentious aspects. For the vast major - ity of patients, outcome is excellent irrespective of the extent of surgery . The low number of recurrences and deaths has made prospective t...

Surgical treatment for differentiated thyroid cancer This subject has many contentious aspects. For the vast major - ity of patients, outcome is excellent irrespective of the extent of surgery . The low number of recurrences and deaths has made prospective t...

THYROID ENLARGEMENT The normal thyroid gland is impalpable. The term goitre (from the Latin guttur = the throat) is used to describe generalised enlargement of the thyroid gland. A discrete swelling (nodule) in one lobe with no palpable abnormality elsewhere ...

THYROIDITIS Chronic lymphocytic (autoimmune) thyroiditis (Hashimoto’s disease) This common condition is usually associated with raised titres of thyroid antibodies. It commonly presents as a goitre, which may be di ff use or nodular with a characteristic ‘boss...

THYROIDITIS Chronic lymphocytic (autoimmune) thyroiditis (Hashimoto’s disease) This common condition is usually associated with raised titres of thyroid antibodies. It commonly presents as a goitre, which may be di ff use or nodular with a characteristic ‘boss...

Thyroid autoantibodies Serum levels of antibodies against thyroid peroxidase (TPO) and thyroglobulin are useful in determining the cause of thyroid dysfunction and swellings. Autoimmune thyroiditis may be asso - ciated with thyroid toxicity , failure or euth...

Thyroid imaging The workhorse investigation in thyroid disease for the surgeon is ultrasonography . This modality allows assessment of the gland and the regional lymphatics. Not only can the characteristics of the gland substance be quantified, but critically...