Thyroid

Thyroid Revision Dr.
Al Matary
Thyroid
thyroid
Goiter
thyroid
histology Physiology anatomy
thyroid
Goiter
Hashimoto's thyroiditis
follicle antibody Hashimoto's thyroiditis

thyroid
Page | 1
Thyroid Revision Dr. Al Matary
goiter
thyroid
auto immune reaction Hashimoto's
auto immune reaction

granulation tissue auto immune inflammation
gland
gland Hashimoto
sub acute thyroiditis
fibrosis Riedel's Riedel's thyroiditis

gland fibrosis gland
Normal gland Riedel's thyroiditis
Myxedema
Goiterous 
Non goiterous 
Hashimoto's Goiterous myxedema

Primary myxedema Non goiterous myxedema
gland T.B.
non goiterous myxedema
goiter
goiter thyroid
Normal finding normal gland thyroid
Goiter
is a swelling Goiter
Page | 2
small thyroid small goiter

normal thyroid Small thyroid
gland small goiter
gland Huge goiter
goiter
enlarged thyroid gland goiter
small thyroid small goiter
gland Small goiter
diffuse goiter
diffuse goiter
two lobes thyroid goiter
two lobes
Lobular goiter
diffuse thyroid
Lobular goiter
nodule Nodule 19 nodules gland
measuring
Lobular
gland Nodules
normal goiter
Lipoma swelling goiter
smooth
Lobulated
lobules
swelling lipoma
Page | 3
Is a swelling goiter
diffuse swelling
Lobular
goiter
goiter
Enlarged thyroid gland
throat
throat
goiter
Normal finding thyroid

is a swelling goiter
swelling Hemangioma Lipoma goiter
nodular diffuse swelling
thyroid
goiter thyroid
thyroid
 anaplastic Papillary carcinoma

thyroid
goiter thyroid thyroid

sub acute Decurvan's thyroiditis
Hashimoto's
gland
toxic gland toxic

toxic toxicity
thyroid
toxicity
simple exclusion
Page | 4
goiter
Simple goiter 
Toxic goiter 
Inflammatory goiter 
Neoplastic goiter 
clinically
clinical
We exclude malignant, we exclude inflammation, we exclude toxicity
Simple
simple goiter
text
clinical
by exclusion simple goiter clinical
goiter
cachexia
toxicity
Metastasis
malignant
Inflammation
by exclusion simple goiter goiter
Page | 5
Goiter
Enlarged thyroid gland goiter
No , it is normal finding Is a swelling thyroid
thyroid is a gland

Is a swelling goiter
goiter thyroid
Neoplasm
Inflammation
toxicity
simple
simple gland
toxicity Inflammation Malignancy History
simple
simple goiter
gland simple goiter
simple diffuse 
simple lobular Nodules 
Simple diffuse goiter 

Simple nodular goiter 
extremes
may be medical simple diffuse goiter
may be surgical simple nodular goiter
simple diffuse goiter

thyroid
Normal finding
nodules
Page | 6
Surgery Nodules
simple goiter
simple goiter
Simple diffuse 
Simple nodular 
Medical disease mainly simple diffuse

surgical disease mainly simple nodular
history
malignant
toxicity
simple
simple nodular simple diffuse

conservative simple diffuse
surgery simple nodular
toxic
toxic
malignant
Page | 7
cachexia
inflammation
simple goiter
nodular diffuse
diffuse
to confirm
hydrocephalus diffuse
nodular
Nodular diffuse
simple diffuse goiter

Physiological goiter simple diffuse goiter
physiological goiter
Venus neck
Venus neck
Venus
Venus neck
Venus neck physiological goiter
Metabolism
Thyroxin
Page | 8
Venus neck
Normal physiology
gland
Metabolism
metabolism
gland
Normal physiology
normal
goiter
thyroxin
TSH
gland
Page | 9
gland
gland thyroxin gland
endemic goiter
available
diffuse
goiter diffuse
goiter diffuse
physiological
 12
Physiological goiter
17 15
endemic
endemic physiological
sporadic goiter
Page | 10
Theory
goiter
goiterogenic
goiterogenic
thyroid
Actually
thyroid factor
factor
anti body
actually
sporadic goiter
Conservative
goiterogenic
Medical
medical endemic goiter
sporadic goiter
gland
thyroxin
gland TSH
colloid diffuse goiter

colloid goiter
colloid goiter
gland under stimulation of TSH for long time
Page | 11
TSH gland endemic goiter

gland TSH
large dose of iodine
IVP
rich in iodine
IVP endemic goiter
TSH 
protease enzyme follicle follicle Inhibit enzyme 
follicle Protease
thyroxin colloid
direct action TSH direct TSH 

protease 
thyroxin follicle colloid protease
Protease
colloid
Protease colloid
colloid Protease
follicle colloid Directly 
follicle colloid
colloid goiter
IVP
IVP
IVP
colloid
Page | 12
huge size colloid goiter
dyspnea huge size colloid goiter

dyspnea to relieve
usually
colloid goiter usually
goiter
toxicity Inflammation Neoplasm History
Simple exclusion
simple goiter history

examination
Nodular diffuse
diffuse
it means what diffuse
follow up 
medical treatment 
nothing Physiological goiter 

Endemic goiter 
Nothing thyroxin Sporadic goiter 
Colloid goiter 
Medical
simple goiter History

nodular
Nodules
Page | 13
simple nodular goiter

goiter goiter
goiter
how to investigate and confirm
simple nodular goiter simple diffuse goiter
medical simple diffuse goiter

endemic
sporadic goiter

treatment Investigations clinical pictures complications pathology
Simple Nodular Goiter

Unknown etiology
Theory

TSH TSH
gland vascularity TSH
vascularity TSH
TSH
Page | 14
Stress TSH
vascularity TSH
TSH
vascularity
vascularity TSH
TSH
vascularity vascularity
vascularity Vascularity
vascularity
TSH TSH
Blood vessel
Hemorrhage
gland hemorrhage
Hematoma Hemorrhage
fibrosis end result hematoma
Nodule nodule Nodule

Nodule

stress axis
stress axis
involution revolution cycle
Multi nodular goiter
theory
Page | 15
Cosmetic disfigurement
gland simple nodular goiter
gland
gland simple nodular goiter

goiter
cosmetic disfigurement
Population
gland
gland
potentially
Potentially
Potentially toxic gland

autonomous
autonomous
TSH receptors autonomous
TSH TSH
Page | 16
TSH receptors
receptors
thyroxin thyroxin thyroxin TSH
gland
autonomous
thyroxin thyroxin thyroxin
Toxic
potentially toxic nodules gland

malignant

sudden death
blood vessel
acute
trachea
sudden death simple nodular goiter
hemorrhage
gland hemorrhage
trachea gland
Page | 17
malignancy
surgical simple nodular goiter
pathology
TSH Level fluctuation involution revolution cycles
complications
toxic
disfigurement

cosmetic disfigurement mainly
very good observer


pressure manifestations gland

recurrent laryngeal nerve esophagus trachea Pressure
dyspnea trachea
dysphagia esophagus
change of voice recurrent laryngeal nerve
syncopal attack carotid
Pressure manifestations
Page | 18

Pressure manifestations cosmetic disfigurement
complications
toxicity Hemorrhage
complications
cosmetic disfigurement simple nodular goiter

change of voice dysphagia dyspnea
cosmetic disfigurement simple nodular goiter

dyspnea
dyspnea
retro sternal extension change of voice dysphagia

retro sternal extension
 thyroid
dyspnea
retro sternal extension change of voice dysphagia
retro sternal extension
investigations simple nodular goiter
simple confirm
thyroid function test

TSH T3 and T4
simple To confirm
Page | 19
simple goiter
T3, T4 and TSH
Normal
Normal simple goiter
Normal T3, T4 and TSH

nodular confirm
thyroid nodules Investigations
Ultra sound
The most sensitive investigation to detect the nodules

ultra sound
nodules
malignant to confirm
dominant nodule nodules fine needle aspiration
nodule Fine needle aspiration
dominant nodule
How to investigate the patient with simple nodular goiter


euthyroid To prove
nodular To prove
fine needle aspiration

Nodules
Nodule dominant nodule
simple nodular goiter Iso tope scan

simple nodular goiter anti body
Page | 20
fine needle aspiration Ultra sound thyroid function test simple nodular goiter
 
assess
Liver function tests CBC
simple nodular goiter Investigations
subtotal thyroidectomy
partial thyroidectomy
partial subtotal
Normal
thyroid normal
Normal tissue
Normal gland
Partial thyroidectomy
Normal gland
normal apparently
Potentially gland
Nodule
stress
Nodules
re exploration of the neck
re exploration of the neck
Page | 21
fibrosis healing
fibrosis
trachea
recurrent laryngeal
carotid sheath
Normal lobe 1/5
subtotal thyroidectomy Partial thyroidectomy

Incidence of recurrence
To avoid re exploration of the neck
total thyroidectomy
thyroxin for life
Total thyroidectomy and thyroxin for life better than re exploration of the neck
Nodules
Normal thyroid Nodules
normal tissue Nodules
recurrence

to decrease the recurrence
normal Normal
total thyroidectomy :
Page | 22
Total thyroidectomy and thyroxin for life, better than re exploration of the neck
total thyroidectomy
accidently malignancy
accidental malignancy subtotal

completion thyroidectomy
thyroidectomy

Pathology
thyroid
normal findings
goiter
simple goiter
exclusion
history toxicity inflammation Neopalsm
simple
simple goiter history clinically

examination
nodular diffuse gland
medical diffuse goiter

surgical Nodular goiter
surgical nodular goiter
Involution revolution cycles

complications
hemorrhage toxicity Cosmetic disfigurement
clinical pictures
Cosmetic disfigurement
Page | 23
pressure manifestations
Investigations
euthyroid Thyroid function tests to prove
nodular Ultra sound to prove
dominant nodule Nodule biopsy
gland normal Partial thyroidectomy
subtotal Partial
Incidence of recurrence To decrease
subtotal
normal lobe Normal lobe
jump
Total thyroidectomy to avoid re exploration of the neck
accidental malignancy
conservative treatment

Nodule simple nodular goiter
collar incision
Page | 24
gland
gland
recurrence
thyroxin
Exogenous thyroxin
TSH
gland
thyroxin TSH fluctuation

avoid
gland
medical thyroidectomy
gland thyroxin thyroxin

medical thyroidectomy
necrosis nodules alcohol nodules
nodules Nodules
gland
gland
chemical necrosis gland
Trial
Page | 25
Normal gland
recurrence
accidental malignancy recurrenc to avoid total thyroidectomy
medical thyroidectomy Conservative
Toxic goiter
Toxic Goiter
toxic goiter
Toxic 
goiter 
toxic goiter
goiter Toxic
toxic
toxic goiter
toxicity
toxicity
circulating adrenaline thyroxin

toxicity
irritable Nervous
Palpitation
Page | 26
High cardic output heart failure
heat intolerance
toxicity
due to increased sensitivity of the tissues to adrenaline
toxic
Goiter toxic
goiter toxic goiter

toxic
toxic goiter is a must toxicity
fine tremors night mares insomnia toxic goiter

High cardic output heart failure Palpitation Irritability
increased apetite Heat intolerance
goiter
gland toxic
diffuse toxic goiter diffuse
Primary toxic goiter
primary diffuse gland

Primary thyrotoxicosis
diffuse toxic goiter
Nodular gland
secondary thyrotoxicosis
gland nodule
toxic nodule
toxic goiter
toxic
Page | 27
toxicity
toxic goiter toxicity

goiter
primary thyrotoxicosis diffuse gland
secondary Nodular
toxic nodule Nodule
toxic diffuse gland

toxic nodular gland
toxic Nodule gland
theory
theory
auto immune diffuse goiter
abnormal antibody
Long acting thyroid stimulating hormone
TSI
Thyroid stimulating immune globulins
anti body
anti body
theory
antibody
auto immune disease
anti body
theory
 biology
Page | 28
anti body
Heat intolerance
toxic
stress
TSH receptors thyroid follicle
barrier
TSH receptor thyroid follicle
barrier
stress
barrier
receptor
Page | 29
receptor
Anti body
abnormal antibody
TSH receptors
Toxic
TSH
TSH anti body TSI
T T
S S
I H
immune globulins
TSI
abnormal antibody
TSH
TSH
48 TSI
Long acting thyroid stimulating
TSI
anti body
TSH
barrier stress
receptor
psychological stress Primary thyrotoxicosis

primary thyrotoxicosis
stress primary thyrotoxicosis

toxic
Nodular secondary thyrotoxicosis

Nodular
Page | 30
potentially gland
autonomous follicle TSH receptors

autonomous
thyroxin
toxic
complicated simple nodular goiter
complicated simple nodular goiter secondary thyrotoxicosis
toxic nodule
toxic nodule
benign tumor
Pathology
adenoma toxic nodule
Hyper functioning adenoma
hyper para thyroidism

para thyroid gland adenoma
adenoma
Pathology
toxic goiter
Toxic & goiter

toxicity toxic
goiter
diffuse
nodular
toxic nodule nodule
Page | 31
Primary thyrotoxicosis pathology

after psychic trauma auto immune disease
secondary thyrotoxicosis Pathology
acquiring autonomous activity complicated simple nodular goiter
TSH receptors autonomous
toxic nodule
Hyper functioning adenoma
toxic manifestations
clinical
Pressure manifestations toxic manifestations
clinical pitures
heat intolerance palpitation Irritability fine tremors Night mares Insomnia

exophthalmos
sweaty
bone pain Myopathy muscle
auto immune toxicity
auto immune manifestations of toxicity

Pre tibial myxedema clubbing
true exophthalmos
auto immune
true exophthalmos pre tibial myxedema clubbing

toxicity
Pre tibial myexdema clubbing true exophthalmos
toxicity
auto immune manifestations
primary
auto immune
Page | 32
auto immune Primary thyrotoxicosis

thyroid acropathy clubbing
Primary true exophthalmos Pre tibial myxedema
toxicity
auto immune manifestations
clinical pictures
toxicity
primary auto immune
:
Primary thyrotoxicosis 
Secondary thyrotoxicosis 
Toxic nodule 
toxic goiter
goiter
toxic nodule secondary thyrotoxicosis primary thyrotoxicosis

History
history

history
Toxic manifestations
toxic nodule secondary Primary

gland
Primary diffuse 
secondary Nodular 
toxic nodule Nodule 
toxic goiter
History
History
toxicity
toxic
Page | 33
toxic
Goiter
goiter
goiter
toxic goiter
toxic
toxicity
goiter
goiter
on top of normal thyroid Primary thyrotoxicosis
normal thyroid
goiter
toxicity
gland
On top of normal thyroid
On top of simple nodular goiter
Nodular gland
secondary thyrotoxicosis gland
Past history of thyroid disease primary thyrotoxicosis
toxicity
gland
nodular goiter
primary thyrotoxicosis gland

secondary
Page | 34
Normal gland
small goiter
disease course
auto immune disease Primary thyrotoxicosis
fluctuated
Progressive disesase secondary thyrotoxicosis

autonomous activity
progressive toxic nodule
auto immune auto immune disease fluctuating in course Primary thyrotoxicosis 

disease
anti body
rheumatoid arthritis
auto immune disease

fluctuating in course
receptors secondary thyrotoxicosis 

acquired autonomous activity
receptors
Progressive
Toxic nodule 
Progressive toxic nodule

primary fluctuating
Page | 35
toxic goiter
course
primary thyrotoxicosis fluctuating
toxicity fluctuating
Myxedema relation
fluctuating
toxicity gland
spontaneous remission
Myxedema spontaneous remission
treatment of choice surgery
radio active iodine

radio active iodine
radio active iodine
radio active iodine

gland radio active iodine
gland
radio active iodine
gland
myxedema spontaneous remission

main line of treatment
Medical
thyroxin medical
Page | 36
Medical treatment spontaneous remission
primary thyrotoxicosis Line of treatment

Medical treatment
The best line of treatment

Medical primary thyrotoxicosis
fluctuating
Primary thyrotoxicosis medical treatment

Waiting
primary thyrotoxicosis medical treatment

Waiting for spontaneous remission
Iam waiting for spontaneous remission
Statistically
Indication for surgery
Primary thyrotoxicosis medical treatment

Page | 37
Maximum
Medical treatment
radio active iodine
radio active iodine
radio active iodine
radio active iodine
toxic goiter
goiter toxic
toxic
Increase level of thyroxin in blood
Increase sensitivity of the tissues to circulating catecholamines
palpitation Irritability night mares
high cardic output heart failure
toxicity
toxic goiter
goiter
gland
past history of thyroid disease Diffuse
gland
Page | 38
past history of simple nodular goiter Nodular
toxic nodules
Benign tumor
benign tumor toxic nodule
Auto immune reaction
barrier psychological stress
gland Autonomous activity
TSH receptors
toxic nodules
Benign tumor
disease
Fluctuation
auto immune disease
Progressive
abnormal Autonomous activity
toxic nodule
Progressive
benign tumor
type of patient primary thyrotoxciosis

Female
psychological stress
type of patient
Page | 39
psychological stress Female
complicated
female

complications
toxic nodule
benign tumor
type of patient
treatment
medical treatment
Waiting for what
indication for surgery spontaneous remission

radio active iodine
surgery
radio active iodine surgical
progressive
you are waiting for what
medical treatment
You are waiting for what
Page | 40
progressive
you are waiting for what progressive
Go ahead
radio active iodine
radio active iodine efficacy fibrosis fiborsis gland
fibrosis gland
Beta irradiation
Penetration power Beta irradiation
gland fibrosis
Page | 41
efficacy
secondary thyrotoxcicosis
radio active iodine
fibrosis gland
radio active iodine gland
gland
surgery main line of treatment

gland
nodular
nodular gland
fibrosis
Beta irradiation penetration
surgery
However
heart failure
Heart failure
heart failure
Page | 42
cost benefits
treatment of primary thyrotoxicosis

Medical treatment
Waiting for what
maximum
Indication for surgery remission
radio active iodine
Surgery
medical treatment
Waiting for what
radio active iodine

fibrosis gland
Heart failure
radio active iodine
toxic nodule
course
fluctuating primary thyrotoxicosis
Page | 43
treatment
medical
thyrotoxicosis
adenoma gland
Progressive in course
medical
medical
Waiting for what
Nodule
radio active iodine main line of treatment
Toxic nodule
radio active iodine 

Page | 44
medical treatment progressive

Waiting for what
radio active iodine
fibrosis gland
radio active iodine

Main line of treatment
radio active iodine
radio active iodine surgery Medical
medical treatment
radio active iodine
surgery
Medical treatment
Neomercazole Carbimazole
5
condition severity
Beta blocker inderal

beta blocker Inderal
Page | 45
due to increased sensitivity of the tissues for circulating toxicity 

catecholamine
Alpha Beta
Over active Beta receptors
alpha
cyclic AMP Beta
beta receptors activity Over increase

alpha
beta blocker
Indral 
Neomercazole
thyroxin
gland thyroxin
neomercazole
thyroxin Neomercazole
gland
neomercazole
Neomercazole inderal
Inderal
Inderal
neomercazole
Page | 46
Hepatotoxicity agranulocytosis Neomercazole

side effects
Hepatotoxicity agranulocytosis
hepatic toxicity
sore throat agranulocytosis
neomercazole side effects

Thiouracil goiter Neomercazole
thyroid
Thiouracil transmitted goiter

gland baby
neomercazole
thiouracil goiter
gland neomercazole goiter
Thiouracil transmitted goiter

goiter
Primary thyrotoxicosis Main line of treatment

Medical
Inderal Neomercazole
agranulocytosis hepatotoxic Neomercazole
Page | 47
sore throat agranulocytosis
thiouracil goiter
Thiouracil trasmitted goiter
thiouracil transmitted goiter
Medical treatment
Neomercazole carbimazole
goiter
thyroxin thiourea group
TSH thyroxin
TRH
Molecular weight TRH

palcenta
thyroid
TSH Mother TRH

gland
gland
TRH
gland
TRH
gland
TRH
Page | 48
carbimazole
prophyl thiouracil
thiouracil group
thyroid
 clinical
carbimazole
Propyl thiouracil
Placenta
TRH thiouracil transmitted goiter
surgical treatment
surgical treatment
total toxic goiter

total toxic goiter
total
To avoid recurrence
toxicity extremely rare malignancy to avoid malignancy
toxicity extremely rare malignancy
total thyroidectomy toxic goiter

To avoid recurrence
primary thyrotoxicosis total thyroidectomy
failure of medical treatment
total thyroidectomy
total primary thyrotoxicosis
diffuse
total nodular
Page | 49

Primary
recurrence
fluctuating
Progressive
recurrence
total thyroidectomy Primary
antigen antibody reaction
antibody antigen
total thyroidectomy
recurrence
antibody antigen
Medical
Medical
Inderal Neomercazole
neomercazole
Page | 50
Surgery
surgery
Subtotal thyroidectomy
After preparation
after preparation
euthyroid medical treatment
euthyroid
thyrotoxic crisis
after preparation subtotal thyroidectomy

Preparation
nodular Toxic
past history of simple nodular goiter
subtotal thyroidectomy after preparation
medical treatment
euthyroid
progressive
Page | 51
Mongol
 secondary thyrotoxicosis
toxicity toxicity toxic
Nodular gland Secondary
past history of simple nodular goiter
female type of patient
by surgery secondary thyrotoxicosis
surgery
thyrotoxic crisis subtotal thyroidectomy

subtotal thyroidectomy after preparation
hematemesis
subtotal thyroidectomy after perperation
Perperation
euthyroid Medical treatment Perperation
Page | 52
medical treatment
euthyroid
medical treatment euthyroid
by surgery
Medical treatment
Medical treatment
medical treatment
medical
secondary thyrotoxicosis medical treatment
subtotal thyroidectomy euthyroid
15
16
treatment of secondary thyrotoxicosis
after preparation subtotal thyroidectomy
antithyroid drugs preparation

euthyroid
Page | 53
Lugol's iodine
anti thyroid drugs
euthyroid
euthyroid
Lugol's iodine
vascularity of the gland Lugol's iodine
Lugol's iodine medical treatment
Lugol's iodine
Lugol's iodine
Lugol's iodine
anti thyroid drugs

euthyroid
Lugol's iodine euthyroid

vascularity of the gland
vascularity of the gland
colloid follicle
colloid follicle
compressed inbetween blood vessel
colloid follicle
colloid follicle
squeezed compressed Inbetween blood vessel
vascularity
Page | 54
peak effect
Lugol's iodine
effect
effect 14
tolerance
effect
Lugol's iodine
effect
peak
effect
toxic nodule
toxic nodule
radio active iodine treatment
surgery
surgery
lobectomy
Nodule lobe
Lobectomy
Nodule
Radio active iodine

radio active iodine
swelling
20
Page | 55
20
160
Radio active iodine
radio active iodine

gland
rough gland
calculation of the dose difficulty
radio active iodine

toxic
myxedema
myxedema
myxedema radio active iodine The commonest side effect

difficulty calculation of the dose Myxedema
Myxedema radio active iodine commonest side effect

myxedema common side effect
Maignancy radio active iodine

Pre cancerous Not proved
not proved to be pre cancerous 35
myxedema radio active iodine commonest side effect
Page | 56
radio active iodine

gland
Beta irradiation
esophagus trachea
Beta irradiation
esophagus trachea
radio active iodine
radio active iodine

gamma irradiation
esophagus trachea
recurrent laryngeal nerve
Beta irradiation
gamma 1 % Beta 99 %
gamma camera Isotope scan
gamma camera Iso tope scan
Beta
Beta Irradiation 99 %
thyroid iso tope scan

gamma
Page | 57
irradiation radio active iodine

99 %
gland radio active iodine

Beta irradiation
thyroid iso tope scanning gamma 1%

1%
swelling radio active iodine

swelling
1/8

difficulty
radio active iodine commonest complication Net result

myxedema
Primary thyrotoxicosis treatment

toxic nodule
medical treatment
surgical treatment
radio active iodine
examiner
special problems
thyrotoxicosis
thyrotoxicosis
Page | 58
thyrotoxicosis
simple nodular goiter secondary
toxic
toxic nodule
Benign tumor
medical main line of treatment Primary
near total thyroidectomy surgery

gland
gland gland
re exploration
children thyrotoxicosis
near total thyroidectomy Indication for surgery
gland
thyrotoxicosis
Propyl thiouracil
Neomercazole
teratogenic Placenta
propyl thiouracil
proplyl thiouracil
medical Main line of treatment
Page | 59
surgery main line of treatment
stress
Irritable
threatened abortion
irritable Uterus
uterus
Uterus
placenta
infarction
level
Uterus
placenta
infarcted
Uterus
thyrotoxicosis with pregnancy
primary
Page | 60
toxic
Medical treatment
Mainly medical
propyl thiouracil

thyrotoxicosis
Primary 
secondary 
medical primary
Propyl thiouracil
placenta Propyl thiouracil
Propyl thiouracil
Placenta
Propyl thiouracil
placenta
Propyl thiouracil
thyroid
Page | 61
Pituitary axis
thyroxin Propyl thiouracil

TRH TSH
Placenta TRH
thyroid TRH
uterus
vertebrae
 Posterior Left occipito anterior
thyroid thyroid
brow presentation
face presentation
biparietal diameter
Obstructed labour
Propyl thiouracil
Page | 62
thyroid
TRH TSH
thyroid
well developed thyroid

Mother TRH
gland
Propyl thiouracil
Propyl thiouracil
small dose of synthetic thyroxin Propyl thiouracil
TRH TSH suppression synthetic thyroxin
small dose of exogenous thyroxin Propyl thiouracil

TRH TSH suppress exogenous thyroxin
placenta
small dose of synthetic thyroxin propyl thiouracil
Thyrocardia
heart failure thyrotoxicosis
Heart failure thyrotoxicosis
primary
Primary
Page | 63
 24
training suit
thyroxin
110
110
120
Heart failure Primary thyrotoxicosis 120
thyrotoxicosis
hight cardic output heart failure
secondary thyrotoxicosis Incidence of heart failure
High rate not compensated
Heart failure thyrotoxicosis
fibrosis gland
fibrosis gland
Progressive secondary thyrotoxicosis
Page | 64
However
Heart failure
radio active iodine
radio active iodine

radio active iodine
IQ
true exophthalmos primary thyrotoxicosis

true exophthalmos Primary thyrotoxicosis
Medical waiting for spontaneous remission
with true exophthalmos primary thyrotoxicosis

Medical treatment , waiting for spontaneous remission
clubbin primary thyrotoxicosis

Medical, waiting for spontaneous remission
pretibial myxedema Primary thyrotoxicosis

Medical, waiting for spontanous remission
Primary thyrotoxicosis Pretibial myxedema clubbin true exophthalmos

manifesations of auto immune disease
happy surprise
Grave's disease
Medical treatment
gland
euthyroid
Page | 65
thyroxin
TSH
gland
thiouracil goiter gland
 
gland
Infection
pan ophthalmitis
true exophthalmos Primary thyrotoxicosis

Medical treatment
gland
Medical treatment
TSH thyroxin
exophthalmos producing factor TSH
TSH
 TSH
theory
Page | 66

TSH
exophthalmos producing factor
thyroxin anti thyroid drugs

TSH
exophthalmos producing factor
small dose of thyroxin

anti thyroid drugs
Exogenous thyroxin
TSH exophthalmos producing factor
anti thyroid drugs
theory
exophthalmos
false exophthalmos true exophthalmos
true exophthalmos
Due to exophthalmos producing factor
TSH pituitary
exophthalmos producing factor true exophthalmos

TSH Pituitary
Page | 67

anti thyroid drugs
gland

gland
TSH suppression exogenous thyroxin
thyrotoxicosis
thyrotoxicosis with pregnancy
thyrtoxicosis with true exophthalmos
small dose of thyroxin anti thyroid drugs
thyrotoxicosis with pregnancy thyrotoxicosis

true exophthalmos thyrotoxicosis
small dose of thyroxin anti thyroid drugs

TSH To suppress
exophthalmos producing factor suppress TSH Suppress
L thyroxin 3
thyrotoxicosis
Inflammation
Inflammatory Goiter
Inflammation
inflammatoy goiter
Page | 68
Inflammatory goiter
Hashimoto's Thyroiditis
Inflammatory goiter
Hashimoto's
common
Hashimoto's
thyroid follicle antibody
thyroid follicle antibody

thyroglobulins
colloid
colloid antibody
follicle colloid
thyroid
antibody
follicles
follicle
Askanazy cells
Askanazy cells
Page | 69
Askanazy cells follicle
Auto immune disease
auto immune disease

females more common in males
more common in females
lymph nodes spleen Liver

auto immune disease Primary thyrotoxicosis
fluctuating Progressive
Fluctuating in course
chronic condition Hashimoto's thyroiditis
antibody
antibody
chronic Hashimoto's thyroditis
Hashimoto's
Hashimoto's
Auto immune disease
thyroglobulin antibody against
antibody
follicle
follicle follicle
Askanazy cell
antigen antibody reaction gland
Page | 70
goiter
granuation tissue
Fibrosis heal
Nodules
Nodular gland
nodular gland Hashimoto's
simple nodular goiter Nodular gland
simple nodular goiter Hashimoto's clinically

myxedema
euthyroid simple nodular goiter 
hypothyroid Hashimoto's 
colloid follicle
Hashi toxicosis
Hypo thyroidism
Hashimoto's
Hashi toxicosis 
Hashi moto's 
Hashitoxicosis
Hashimoto's
Hashimoto's
Auto immune
against antibody
thyrogloublin
Page | 71
primary thyrotoxicosis antibody Hashimoto's anti body

primary thyrotoxicosis antibody 
Hashimoto's antibody 
gland primary thyrotoxicosis antibody

gland Hashitoxicosis antibody
Hashimoto's
Hashitoxicosis colloid
follicle
Hashimoto's
radio active iodine Hashitoxicosis

cold hot
Hashimoto's Hashitoxicosis
toxic
radio active iodine
cold
increase uptake
temperoary Output
Hot radio active iodine primary thyrotoxicosis
gland LATS
Over active
LATS Primary thyrotoxicosis

TSI
gland TSH
thyroxin gland
thyroxin
Page | 72
Hashitoxicosis
Increase uptake
follicle toxicity
idoine increase uptake
Primary thyrotoxicosis Hashitoxicosis

Iso tope scanning
antibody
iso tope scanning

primary thyrotoxicosis hot gland
Hashitoxicosis cold warm
follicle
Askanazy
Hashimoto's
Nodular gland
myxedema
mxyedema
Myxedema
Myxedema
Page | 73
Myxedema
hypothermia
myxedema
Hashimoto's
Myxedema
myxedema
follicle destruction
follicle
Anti body
Thyroxin and cortisone
Thyroxin
Myxedema
antibody
Myxedema follicle antibody
thyroxin myxedema
cortisone antibody
malignancy Rare
follow up
thyroxin myxedema
Page | 74
follicle antibody
Rare to turn malignancy

Follow up
follow up
cortisone thyroxin
follow up
malignant
behaviour Sudden change

Lymph node gland
follicle change
for fear of malignancy total thyroidectomy Hashimoto's
Malignancy rare
Indication rare
follow up Indication
Hashimoto's incidence of malignancy

treatment
Total thyroidectomy
Prophylactic
Hashimoto's incidence of malignancy

treatment
follow up thyroxin
Page | 75
follow up
malignancy rare
Inflammation
Riedle's thyroiditis
Riedle's Thyroiditis
Frozen neck 

biopsy isthmectomy 
frozen neck Riedle's thyroiditis
frozen neck
neck gland fibrosis
neck
frozen neck
Neck gland Extensive fibrosis

Neck
frozen neck
gland
goiter
neck fibrosis
thyrodi
Riedle's thyroiditis
minded rare 
differential diagnosis of malignant goiter 
Riedle's
Minded rare
Page | 76
Riedle's
fixed hard gland Frozen neck
malignant
fixed hard Gland
recurrent laryngeal esophagus trachea thyroid
to prove biopsy isthmus
fibrosis
Mediastinum fibrosis
lung great vessesl
ureter Intestine
jaundice

fatal Riedl's thyroiditis
frozen neck
frozen neck
De Quervain thyroiditis inflammation

De Quervain thyroiditis
auto immune thyroiditis
Mumps of the thyroid gland
mumps
painful gland
Mumps
painful gland
Painful Parotid
Page | 77
Mumps of the thyroid gland

painful gland
mumps
Mumps
malaise headache anorexia fever
Fever, anorexia, headache, malaise
Parotid
fever , anorexia , headache and malaise
Mumps
clinical pictures of sub acute thyroiditis

Fever, anorexia, headache and malaise
thyroid
Mumps
Conservative
anti pyretics fluids Analgesics
Conservative
Fluid, analgesic and antipyretics
Page | 78
Mumps end result
De Quervain thyroiditis end result
gland
toxic
Hashitoxicosis
myxedema
Hashimoto's
myxedema Hashimoto's
chronic Hashimoto's
subacute De Quervain
chronic Hashimoto's
myxedema
sub acute thyroiditis De Quervain thyroiditis

sub acute
Normal toxic
Normal Myxedema
stage stage stage Stage
toxic
Page | 79
myxedema
normal myxedema toxic
Hashimoto's
Myxedema myxedeme Hashimoto's
thyroid
Thyroid neoplasm
Thyroid Neoplasm
thyroid gland carcinoma
Lymphoma carcinoma of thyroid gland
malignant goiter
connective tissue epithelim
malignant goiter
carcinoma sarcoma Lymphoma

Lympho sarcoma
Lympho sarcoma
epithelium tumor lymphoma
carcinoma of the thyroid gland malignant goiter
thyroid epithelium
follicle
cancer breast
Page | 80
Lobular ductal
exocrine breast
acini Lobe epithelium
duct
acini carcinoma of the thyroid
thyroid acini
follicular cells 
calcitonin C Cells 
medullary carcinoma C cells
malignant papillae follicular cells

Malignant papillae
papillary carcinoma
follicle
signs of mitosis Loss of polarity Follicles
follicular carcinoma
irregular sheets of malignant cells

anaplastic carcinoma
adeno carcinoma
papillae papillae adeno carcinoma
follicle
anaplastic sheets of cells undifferentiated
carcinoma of the thyroid gland
anaplastic follicular Papillary
follicular cells
Page | 81
Medullary carcinoma Para follicular cells
follicualr cells Papillary carcinoma

Malignant papillae
malignant papillae
epithelium vascular connective tissue core papillae
signs of mitosis loss of polarity epithelium
Malignant papillae
malignant papillae
malignant papillae
Papillae
eptithelium vascular connective tissue core
malignant
signs of mitosis Loss of polarity
Psammoma bodies
Psammoma bodies
follicle Malignant
signs of mitosis loss of polarity follicle follicle malignant
anaplastic
severely undifferentiated
sheets of malignant cells severely undifferentiated

glandular arrangement
severly undifferentiated
papillary carcinoma
Hereditary chronic irritation benign tumor
benign tumor
Page | 82
papillary adenoma
papillary carcinoma
chronic irritation
neck irradiation chronic irrtation
neck Irradiation T.B. lymphadenitis
papillary carcinoma
common
T.B. lymphadenitis
neck irradiation
fibrosis end arteritis obliterans
neck Irradiation
papillary carcinoma
treatment
papillary carcinoma benign tumor

papillary adenoma
chronic irritation
Neck Irradiation
Godwen Syndrome
cancer thyroid cancer breast
Godwen Syndrome
Hereditary chronic irritation benign tumor follicular carcinoma
factor
Page | 83
follicular adenoma benign tumor

follicualr carcinoma
papillary carcinoma papillary adenoma

follicular carcinoma follicular adenoma
papillary carcinoma papillary adenoma

follicular carcinoma follicular adenoma
follicular carcinoma chronic irritation

Malignant simple nodular goiter
May turn malignancy simple nodular goiter

chronic irritation
basic
hereditary factor chronic irritation benign tumor
predisposing factor
herediatry factor chronic irritation Benign tumor
predisposing factor
type of patient Papillary carcinoma

15
Page | 84
Papillary carcinoma
endemic goiter
toxic
malignant toxic
natural history
natural history
Prognosis
papillary differentiated
follicular differentiation
anaplastic differentiation
Papillary differentiated
Mother cells Papillary
Papillae
Papillae Mother cells
highly differentiated
thyroxin TSH
Mother cells
follicular Mother cells
Page | 85
Mother cells
anaplastic follicle
TSH
prognosis differentiated
differentiated
mother cells
less differentiated
Less differentiated
entamoeba
differentiated
entamoeba
big boss
99
entamoeba
differentiation
Highly aggressive less differentiated
More differentiated
differentiated
follicular radio active iodine papillary
radio active iodine
papillary
Page | 86
follicular
anaplastic
radio active iodine
Prognosis
differentiated
Prognosis
bad prognosis undifferentiated papillary carcinoma

bad prognosis undifferentiated Papillary carcinoma
anaplastic follicular papillary carcinoma Microscopic pictures

star shaped mass
solid
thyroid hollow
Infiltrated cauliflower ulcer
Hollow Organ
Infiltrated cauliflower ulcer
solid organ
star shaped mass
Page | 87
Multi centric Papillary carcinoma

papillary focus focus focus focus
focus anaplastic follicular
multi centric papillary carcinoma
Uni centric anaplastic follicular
Papillary multicentric Uni centric follicular
papillary multi centric

uni centric
focus
Multi centric
unicentric
multi centric
gland Lymphatic spread Multi centric

Intra glandular lymphatic spread
intra glandular lymphatic spread Multi centric
follicular cells anaplastic follicular papillary
malignant papillae papillary

Malignant follicle follicular
undifferentiated sheets of cells anaplastic
differentiated
anaplastic follicular papillary
Page | 88

multi centric papillary carcinoma
Focus
foci
ischemic heart disease

focus
focus multi centric
treatment
papillary carcinoma
gland Limited
Lobectomy
follow up Lobectomy
papillary carcinoma
gland Limited
focus lobectomy
follow up
scientific basis
stomach
complications
complication
Page | 89

data
multi centric
multi centric
focus
focus
foci
gland papillary carcinoma

lobectomy
follow up
Normal foci Follow up
Lymph main line of spread papillary carcinoma

blood Main line of spread follicular carcinoma
direct Main line of spread anaplastic carcinoma
spread
lymph
blood
direct
lymph nodes Papillary carcinoma

lateral aberrant thyroid
Page | 90

malignant lymph node
 surprise
normal clinically thyroid
Lateral aberrant thyroid
sclerosed type papillary carcinoma

primary
Lymph node
Lymph node malignant metastasis

Normal clinically gland
lateral aberrant thyrodi

not congenital anomaly
metastasis of papillary carcinoma

lateral aberrant thyroid is a wrong name
It is not a congenital anomaly
It is a metastasis of papillary carcinoma
thyroid clinically normal Lymph node lateral aberrnat thyroid
blood Main line of spread follicular carcinoma

skull metastasis
applied
human being goiter
skull metastasis follicular carcinoma
direct spread Spread mainly
recurrent laryngeal nerve

dyspnea
Page | 91
carotid
trachea carotid
carotid
sheath

spread carotid sheath
carotid sheath
cancer spread fascia
papillary carcinoma
Lymph node
Inflammation Lymphoma
lateral aberrrant thyroid

goiter
goiter
lateral aberrant thyrodi

goiter
Papillary carcinoma
goiter
lateral aberrant thyroid N.B.
papillary carcinoma
goiter
Papillary carcinoma
solitary thyroid nodule 15
papillary carcinoma
Page | 92
physiological goiter 15
nodule diffuse Physiological goiter

diffuse
Diffuse
papillary carcinoma 15 solitary thyroid nodule
Papillary carcinoma
lymph node
lymph node spread
late early
lymph node early
Solitary thyroid nodule
lymph node late

trachea fixed
change of voice dyspnea
early follicular carcinoma

sudden change of the behaviour
Page | 93
ulceration pain Rapidly increase of size
size sudden change simple nodular goiter
solitary thyroid nodule

early malignancy
Solitary thyroid nodule
simple nodular goiter follicular carcinoma predisposing factor
simple nodular goiter follicular carcinoma

predisposing factor
follicular carcinoma predisposing factor

painful gland
discuss voice change
Predisposing factor
discuss within 6 months
papillary
more aggressive
aggressive Papillary carcinoma

Rapidly progressive with few months
Page | 94
skull metastasis
 skull metastasis
rapidly progressive goiter

change of voice dyspnea
anaplastic
age incidence

papillary carcinoma
differential diagnosis
diffuse Physiological goiter
endemic goiter
diffuse endemic goiter
solitary thyroid nodule 15 clinical diagnosis

papillary carcinoma
follicular
behaviour sudden change simple nodular goiter

Page | 95
rapidly progressive swelling solitary thyroid nodule

Malignancy
age Papillary solitary thyroid nodule Follicular carcinoma
age incidence follicular carcinoma
diagnostic
clinical diagnosis
follicular carcinoma Papillary carcinoma
follicular papillary
anaplastic
radio active iodine
anaplastic
radio active iodine
radio active iodine

anaplastic
anaplastic
radio active iodine
total thyroidectomy operable anaplastic carcinoma

block dissection lymph node
Total thyroidectomy
block dissection lymph node
Page | 96
In operable
Tracheostomy
However
Unfortunately
usually inoperable anaplastic carcinoma
follow up Palliative tracheostomy
early operable
total radical thyroidectomy
Inoperable
incidence
inoperable
Inoperable cases
block dissection lymph nodes total thyroidectomy operable
radio active iodine role
external beam of irradiation

Irradiation
radio active iodine
radio active iodine
Page | 97
total thyroidectomy
cherry pick dissection of lymph node
lymph node
cherry pick dissection of affected lymph node


basket
basket
lymph node Lymph node lymph nodes Internal jugluar vein
cherry picking up of lymph node
microscopic metastasis Normal lymph nodes
radio active iodine
tumor load
total thyroidectomy
cherry picking up of the affected lymph node
block dissection
Internal jugular vein block dissection
Page | 98
anaplastic
radio active iodine Anaplastic
totally
radio active iodine

affected lymph node cherry picking up
papillary
Total thyroidectomy
cherry picking up of the affected lymph node
mxedema
Myxedema
total thyroidectomy
affected lymph nodes cherry picking up
myxedema
Myxedema
apathic
Myxedema
total thyroidectomy
Page | 99
TSH
TSH
thyroxin
TSH
thyroid gland
thyroid
thyroid
Metastasis
Metastasis
metastasis
Metastasis
radio active iodine

radio active iodine
Metastasis Metastasis
radio active iodine total thyroidectomy
radio active iodine

malignant cells thyroid
More differentiated thyroid
Page | 100
thyroid thyroid
thyroid
normal thyroid tissue
Normal thyroid tissue
Metastasis
Metastasis Normal thyroid tissue compete
Normal thyroid tissue

Metastasis
radio active iodine

Metastasis Targeting
total thyroidectomy
Myxedema
TSH
thyroid TSH
Metastasis
radio active iodine
thyroxin
Page | 101
thyroxin
thyroxin
Myxedema
myxedema
radio active iodine
metastasis
metastasis
thyroxin
thyroxin
myxedema
small dose of radio active iodine
metastasis
Metastasis
follow up
follow up
Medullary carcinoma
Medullary Carcinoma ( 6 % )
Medullary carcinoma
Medullary carcinoma
tumor of C cells Medullary carcinoma
familial sporadic
amyloid substance calcitonin serotonin
Page | 102
tumor of C cells
familial Sporadic
amyloid substance calcitonin serotonin
Tumor of C cells
radio active iodine
C cells
Calcitonin
Calcitonin
Calcitonin
di iodo tyrosine Mono iodo tyrosine thyroxin

Coupling
follicular cells thyroxin
calcitonin C cells para follicular cells

thyroxin
medullary carcinoma
sporadic cases
Medullary carcinoma
medullary carcinoma History
medullary carcinoma
familial
Positive family history


Page | 103
familial 
positive family history
familial
Medullary carcinoma 
pheochromocytoma 
hyper para thyroidism 
MEN type two
Medullary carcinoma 
pheochromocytoma 
hyper para thyroidism 
MEN type two
Multiple endocrinal neoplasia type two
MEN type two


hyper parathyroidism Pheochromocytoma
medullary carcinoma
Pheochromocytoma medullary carcinoma
pheochromocytoma
medullary carcinoma
hyper tensive encephalopathy stress Pheochromocytoma
IQ
Page | 104
hyper parathyroidism medullary carcinoma
Medullary carcinoma para thyroid
para thyroidism medullary carcinoma examiner
examiner
medullary carcinoma pheochromocytoma
pheochromocytoma
To avoid hyper tensive encephalopathy


Medullary carcinoma
Clinically
medullary carcinoma
Medullary carcinoma
medullary carcinoma
broncho spasm flushing diarrhea
serotonin
Medullary carcinoma
Amine precusor uptake caboxylase oma 
Carcinoid tumor
appendix
Page | 105
endocrine tumor
spelling
 spelling
biboma somatostatinoma ductloma insulinoma
MEN type two MEN type one
MEN type two MEN type one
neck swelling diarrhea resistant for treatment

Lymph node diarrhea GIT

medullary carcinoma
neck swelling
medullary carcinoma more common in males


medullary carcinoma

diarrhea resistant for treatment

neck swelling Diarrhea resistant for treatment
thyroid swelling Medullary carcinoma
Page | 106
broncho spasm diarrhea flushing

Medullary carcinoma
familial sporadic
family history
Local examination general examination

general examination
Pheochromocytoma
pheochromocytoma general examination
solitary thyroid nodule thyroid swelling

medullary carcinoma
flushing diarrhea
Medullary carcinoma solitary thyroid nodule

flushing Diarrhea
family history
family history
familial
sporadic
Local examination general

general examination
pheochromocytoma Pressure
Page | 107
local examination
swelling
Lymph node
Late early fixation Lymph node swelling
local examination
early
Lymph nodes

human reaction
advanced to what extent

local examination
Local examination general examination
Investigations
Investigations
calcitonin
Marker calcitonin
calcitonin marker
positive family history

Calcitonin

Calcitonin
calcitonin calcitonin
Page | 108
calcitonin
follow up normal calcitonin
calcitonin
examination
calcitonin
medullary carcinoma
Normal calcitonin
happy surprise
total thyroidectomy equal Positive family histoy High calcitonin level

normal thyroid
thyroid total thyroidectomy Positive family history High calcitonin level

Normal Investigations Clinically
normal
Normal iso tope scannin
total thyroidectomy investigations clinically Normal
total thyroidectomy positive family history High calcitonin
Follow up
Medullary carcinoma
medullary carcinoma
swelling diarrhea medullary carcinoma

diarrhea swelling
diarrhea
thyroid
 goiter
diarrhea goiter
Page | 109
broncho spasm flushing diarrhea
Medullary carcinoma
family history
familial sporadic
general examination
pheochromocytoma
Local examination
Lymph nodes local examination
surrounding strctures infiltration
medullary carcinoma
investigations
calcitonin
medullary carcinoma tumor marker
Positive family history

calcitonin
thyroid normal Positive family history calcitonin

examination clinically
total thyroidectomy
MCQ
total thyroidectomy
calcitonin
Ultra sound
ultra sound medullary carcinoma

Nodule
multiple single Nodule
Single
Unicentric
Page | 110
Nodule of
Fine needle aspiration
iso tope scanning
cold
cold iso tope scanning Malignant
fine needle aspiration
medullary carcinoma
Treatment
Medullary carcinoma
total thyroidectomy
block dissection cherry picking up Lymph node

Block dissection
cherry picking up
total thyroidectomy
block dissection Lymph node
medullary carcinoma
Total thyoridectomy
block dissection Lymph node
familial
para thyroid gland 3.5
hyper para thyroidism
Page | 111
total thyroidectomy Medullary carcinoma

Lymph nodes block dissection total thyroidectomy Lymph node medullary carcinoma
Para thyroid gland familial Medullary carcinoma
para thyroid familial Once
thyroid
Thyroid
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Page | 112

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Thyroid Revision Dr.

follicle antibody Hashimoto's thyroiditis

auto immune reaction Hashimoto's

auto immune reaction

sub acute thyroiditis

fibrosis Riedel's Riedel's thyroiditis

Hashimoto's Goiterous myxedema

Normal finding normal gland thyroid

small thyroid small goiter

gland small goiter

gland Huge goiter

Normal finding thyroid

 anaplastic Papillary carcinoma

goiter thyroid thyroid

toxic gland toxic

by exclusion simple goiter goiter

enlarged thyroid gland goiter

Simple diffuse goiter 

simple diffuse goiter

Medical disease mainly simple diffuse

simple nodular simple diffuse

simple diffuse goiter

Venus neck physiological goiter

colloid diffuse goiter

TSH gland endemic goiter

direct action TSH direct TSH 

follicle colloid Directly 

huge size colloid goiter

dyspnea huge size colloid goiter

simple goiter history

nothing Physiological goiter 

simple goiter History

simple nodular goiter

simple nodular goiter

simple nodular goiter simple diffuse goiter

medical simple diffuse goiter

simple nodular goiter

Simple Nodular Goiter

Nodule nodule Nodule

simple nodular goiter

involution revolution cycle

Multi nodular goiter

simple nodular goiter

simple nodular goiter

gland simple nodular goiter

Potentially toxic gland

thyroxin thyroxin thyroxin

potentially toxic nodules gland

simple nodular goiter

simple nodular goiter

simple nodular goiter

sudden death simple nodular goiter

surgical simple nodular goiter

simple nodular goiter

simple nodular goiter

very good observer

pressure manifestations gland

simple nodular goiter

cosmetic disfigurement simple nodular goiter

simple nodular goiter

cosmetic disfigurement simple nodular goiter

retro sternal extension change of voice dysphagia

investigations simple nodular goiter

thyroid function test