Approach to a thyroid nodule. According to american thyroid association guidelines 2005-2006. Anatomy of the Thyroid Gland. Follicles: the Functional Units of the Thyroid Gland. Follicles Are the Sites Where Key Thyroid Elements Function: Thyroglobulin (Tg) Tyrosine Iodine
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Approach to a thyroidnodule
According to american thyroid association guidelines 2005-2006
Thyroid pro-hormone is stored as thryoglobulin as an extracellular colloid
T3 and T4 can cross lipid membranes readily (secretion and uptake)
T3 and T4 are small, hydrophobic and circulate bound to Thyroxine-binding globulin (TBG)
Hx of irradiation
extension below sternocledomastoid
Surgery is indicated after second reccurence.
- > 50 % cystic leision.
- located posteriorly.
papable >U/S guided(0.6%).
1-to remove the primary tumour and its local extension.
2-to minimize treatment related morbidity.
3-to permit accurate staging.
4-fascilitate postop. Radioactive Iodine ttt.
5-fascilitate long term postop. Surveilance
6-minimize disease reccurence and mets.
2- nodule > 4cm and atypia.
3- hx. Of irradiation or positive family hx.
4- bilateral nodules.
5- regional LN or distant metastases.
6- patient preferance for one stage.
7- relative indicationage >45
Levels II,III,IV and V
Done only with biopsy proven metastases after clinical or sonographic suspicion
- age > 45 and extrathyroid extension and high likelyhood of microscopic residual tumour.
-gross residual and further surgery or radioactive iodine treatment is ineffective.