Thyroid Benign Pathology PDF

THYROID PATHOLOGY  INFLAMMATORY PATHOLOGY OF THE THYROID GLAND ♦ there are inflammation of the thyroid gland that can develop: on a normal gland => thyroiditis, on a pre-existing goiter => smurned. (STRUMITĂ)  ACUTE THYROIDITIS ♦ is acute inflammation of the previously...

THYROID PATHOLOGY  INFLAMMATORY PATHOLOGY OF THE THYROID GLAND ♦ there are inflammation of the thyroid gland that can develop: on a normal gland => thyroiditis, on a pre-existing goiter => smurned. (STRUMITĂ)  ACUTE THYROIDITIS ♦ is acute inflammation of the previously healthy thyroid gland; ♦ more common in women between 20 and 40 years old; ♦ it is directly related to: the use of contraceptives, ▪ the PREGNANCY.  Causes: ♦ distant starting point infections hematogenously transmitted: pneumonia ▪ the flu ▪ measles (RUJEOLĂ) acute appendicitis acute cholecystitis ♦ neighborhood infections: ▪ amigdalite phlegmon of the neck direct trauma to the gland  pathologist ♦ the inflammatory process usually affects a single lobe; it evolves in two stages: congested suppurative ♦ after healing => a fibrous tissue with normal gland islands. Clinical ♦ sudden onset with: ▪ fever ▪ chills previous live cervical pain exacerbated by deglution movements, ▪ swelling of the gland ± compressive phenomena: -dyspnea, -dysphagia, -hoarseness; alteration of the general state in the suppurative phase: local fluctuation with ▪ edema of the tissues ♦ can fistulize to the skin: local and general phenomena diminish in intensity you can still get fistulized in: ▪ esophagus ▪ trachee ▪ torace  Treatment The treatment is prophylactic ♦ correct treatment of outbreaks of infection in the vicinity  Curative treatment in the congestive phase: general and local rest local revulsive treatment anti-inflammatory, even corticosteroid broad-spectrum antibiotherapy or after the antibiogram in the suppurative phase the treatment is surgical and consists of: ▪ incizia ▪ wide drainage of the purulent collection  CHRONIC THYROIDITIS the most common and described nonspecific chronic thyroiditis are: - tiroidita limfomatoasă Hashimoto - Riedl wood thyroiditis Riedlsau "iron goiter": it is a less common form it has an autoimmune etiology it mainly affects men ♦ some authors frame it in the evolution of Hashimoto’s thyroiditis  local phenomena sit in: ♦ thyroid sclerosis with chronic evolution infiltrate the surrounding tissues ♦ causes compressive phenomena Hashimoto's lymphomatous thyroiditis it is an autoimmune disease more frequently found in women local phenomena sit in: ♦ transformation of thyroid tissue into fibrous and lymphoid infiltrated tissue; ♦ phenomena never exceed the limits of the gland; Clinical both forms of thyroiditis are manifested by: enlargement of the gland; hard consistency; sometimes nodular character; no satellite adenopathy;  paraclinically ▪ high VSH hypergamaglobulinemia positive antithyroid antibodies unaltered thyroid function histopathological examination = diagnosis of certainty  Treatment ♦ it is not necessary if no compressive phenomena occur ♦ for forms with compression phenomena inconsistent results by: anti-inflammatory radiation therapy ▪ combination: thyroxine – corticosteroids ♦ in forms with large compression phenomena - surgical treatment▪ atypical subtotal thyroidectomy and/or tracheostomy  Gusi ♦ goiter = increase in volume of the thyroid gland by parenchymatoassor /and stromal dystrophy ♦ initially peripheral receptors receive insufficient amounts of thyroid hormones: due to insufficient secrecy - or due to a higher need (pregnancy, puberty, growth,) ♦ deficiency is perceived by the hypothalamus => hypersecretion of TRF ( Thyreotrop releasing factor) => acts on the pituitary => secreted excess TSH (Thyroid stimulating hormone) => thyroid hyperfunction=> diffuse then nodular thyroid hyperplasia ♦ in relation to the functional status of the gland are described: - simple goiter = normothyroid mixed-edematous goiter = hypothyroidism hyperthyroid (hyperthyroid) goiter ♦ in relation to the time of appearance, we distinguish: - congenital goiters genetically transmitted it is a very difficult time to find a way to find a - acquired goiters.sporadic,.endemic  SIMPLE OR NON-NORMAL GOITER ♦ it is a non-inflammatory and non- humoral increase in the number of thyroid gland cells; ♦ have a normal blood titer of thyroid hormones; more interested in the female sex. there is a genetic family disorder probably determined by autosomal recessive transmission. ♦ according to the volume of O.M.S. classifies the goosebumps according to clinical appearance in five stages (0, I, II, III, IV), starting from the individual without a goiter who represents the level 0; The goiter with monstrous volume representing the fourth degree; in a normothyroid goiter, the size of the gland increases 10-20 times the normal size  etiopathogeny Simple normothyroid gloves are classified as: The endemic ♦ when more than 10% of the population of a geographical area is goiter. ♦ it is related to social and geographical factors that act on a community: (mountain areas, improper economic and social conditions and hygiene, undernourishment, etc.). ♦ these factors are: 1.- endemic iodine deficiency the daily requirement for iodine is: -100 micrograms per adult; -150 - 300 micrograme la:.child,.teenager, pregnant; ▪ at a rate less than 40 micrograms per day => goiter; 2.- exogenous goutogenic factors water polluted with excess calcium and magnesium; ▪ excess lipids lack of protein; ▪ food type:.cabbage,.collars, e. g.c.; The sporadic goiter - occurs in a person or small groups ♦ se produce prin: food deficiencies; excessive renal loss of iodine; ▪ by food gusogens; by chemical gusogens;  ▪ by medicated guşogens; autoimmune phenomena; ▪ stress; ▪ cancer extratiroidian, e.t.c.;  SOLITARY THYROID NODULES ♦ it is a tumor formdeveloped in the thyroid parenchyma, ♦ este unilateral. ♦ after the scintigraphic aspect is classified in: cold knot do not fix the radio tracer it is usually a malignant lesion or with high malignant potential;  caldcare thyroid nodules are: hyperfixative in 99% of cases = a benign lesion can be functionally: - normotiroidian, - with thyroid hyperfunction = toxic nodule Anatomopatologic deosebim: parenchymatic goiter it is uniformly enlarged by volume; coloidal gusto ▪ soft, gelatinous consistency in evolution it reaches the cystic aspect;  vascular goiter or pulsating ▪ caused by the proliferation of vascular tissue, especially arterial; fibrous goiter ▪ determined by the proliferation of supportive connective tissue;  the nodular goosemay be: ▪ uninodular polynodular hyperplastic parenchymatic colloidal  Clinical the clinical picture is based on: the anatomical form complications, e.t.c. ♦ in simple gloves, without complications: there are no functional signs there are no endocrine signs ♦ in the large goosethrough compression of neighboring organs appear: the loud voice => hoarse the bitonal voice ▪ aphone ▪ dyspnea ▪ circulation and cornage asthma phenomena ▪ dysphagia headache edema of the head extremity tachycardia  ▪ Claude-Bernard-Horner syndrome - Myosis - enoftalmie - decrease the palpebral slit the volume may vary: very small size, visible only to the extension of the head enormous dimensions - in cystic or colloidal gooseets ♦ consistency: ▪ fermin parenchymatous and fibrous gloves pseudofluctuating in cystic gloves ▪ soft and pulsating in vascular ones inhomogeneity in the nodular Diagnosis ♦ the organ diagnosis is made on : ▪ vertical mobility of the formation with deglutathition; ▪ lateral mobility with passive mobilization of the trachea. ♦ diagnosis of simple normothyroid goiter is made on: ▪ absence :. functional changes in hyper or hypo- function;. clinical and biological inflammatory changes;. anticorpilor antitiroidieni, e.t.c.;  Complications The most frequently encountered ♦ infectious complications => smurites; spontaneous interstitial hemorrhages ♦ posttraumatic hematoma of the thyroid lodge; ♦ malignant degeneration especially in old nodular goosejos; ♦ Basedowicarea: ▪ adenomul toxic Plummer, basedowicated nodular goiter; It shall also be described: mechanical compression on anatomical elements of the neck; ♦ hyperthyroidism;  Treatment ♦ prophylactic treatment: ▪ ensuring the daily need for iodine in endemic areas using: - iodized salt; - tablets with iodine administered discontinuously; hygiene and sanitary measures: - sanitation of water sources, - sanitation of houses; balancing the food system; ♦ curative treatment: in diffuse goiter with: thyroxine; ▪ thyroton for blocking the hypothalamic - pituitary - thyroid axis and ensuring hormonal needs; suppression of diet or medication; the administration of mineral iodine in patients with real iodine deficiency (the "avid" iodine goiter); surgical treatment applies only: in complicated gloves: - hematoma - giant gloves with compressive or aesthetic phenomena - gloves with malignant degeneration, e.t.c. the treatment consists of: - subtotal thyroidectomy; - keeping a blade of posterior thyroid tissue to provide the necessary thyroid hormones;  in nodular goiter surgical treatment consists of: - subtotal or total hemiroidectomy in the single node, - subtotal or totalbilateral thyroidectomy in polynodular goiter, with mandatory extemporaneous histopathological examination;  in the ectopic goiter surgical treatment: - it is mandatory; - consists of subtotal bilateral thyroidectomy;  HYPERTHYROIDIA Definition it is a long-lasting thyroid hyperfunction; includes several clinical entities: ♦ boala Basedow – Graves; ♦ adenomul toxic Plummer; ♦ basedowified nodular goiter; Pathogenesis is affected by female predilection; the ratio of women to men is 9/1, age - between 15-45 years; it occurs more frequently during critical periods: puberty ▪ task ▪ lehuzie ▪ menopause there is a genetic, familial aggregation; Basedow’s disease is considered to be an autoimmune disease. TSH antireceptor antibodies have been isolated from the thyroid membrane;  triggers can be: specific or non-specific infections Metal poisoning (cobalt, Pb,) psycho-emotional factors ▪ CNS lesions (encephalitis, tumors) ▪ hormone therapy ▪ iodine therapy another favorable factor in the appearance of hyperthyroid is preexistence of thyroid pathology  pathologist the thyroid is the seat of hypertrophy and hyperplasia, ♦ in Basedow disease hypertrophy and hyperplasia interest the whole gland; ♦ in the secondary basedowated goiter hypertrophy and hyperplasia is localized, nodular;  at the level of the Tenon capsule increases the fatty tissue, edema and fibrous tissue => exophthalmia; apar leziuni distrofice şi degenerative la nivelul: the cervical sympathetic, the minocardium, the liver, the thymus  Clinic debutante : usually insidious with: the palpitations tachycardia behavior disorders insomnia weight loss  rarely can it be sudden after: strong emotions ▪ intoxication the period of the abbesses describes two kinds of signs: Signs of hormonal hypersecretion: tachycardia is a symptom: ▪ capital ▪ constantly ▪ precoce present and in sleep  it is a normotrop it increases in effort can generate dyspnea ▪ it can be associated with a slight increase in blood pressure; - weight loss : ▪ constantly ▪ early (2-3 months after onset) it is associated with a paradoxical increase in appetite. - basal metabolism ▪ it is raised ▪ clinically expressed by moderate hyperthermia (37.3ºC -37.8ºC), the basedowian cannot withstand the heat;  - other reactions to hyperthyroxinemiesare : menstrual disorders (hypo=> amenorrhea) neuromuscular disorders: - physical asthenia psycho-emotional instability - muscle instability - motor agitation with korean movements  ▪ digestive disorders: - diarrhea - bulimia - sclerotegumentary jaundice - hepatic steatosis  ▪ skin disorders: - pruritus appeared early - thin skin - edema of the mucous membranes permanent tremors accentuated by emotions, e.t.c. Signs due to hypertonia of diencephalic centers: - gussshows hypertrophy : Diffuse and symmetrical gland - in Basedow disease; asymmetric, with nodules in secondary hyperthyroidism; - exoftalmia : ▪ it is determined by a wide open palpebral slot; it is bilateral; symmetrical; ▪ reductible to the compression of the eyeball; no inflammatory or functional phenomena;  when the protrusion of the eyeball exceeds 20 mm => malignant exophthalmia manifested by: - inability to close the palpebral slot - eye pain - photophobia - tears - conjunctivitis - bright eyes the so-called “fish eyes. - tremors are : - permanente - accentuated by emotions - behavioral disorders manifested by: psycho-emotional instability - irritability - emotionality - insomnia - restless sleep Clinical forms Basedow-Graves disease it is a primary hypertireosis. it is also called exophthalmic goiter. occurs in areas with high amount of food iodine;  especially interested young women (between 15-40 years); it appears to be an autoimmune condition. with massive lymphocytic infiltration in the thyroid gland; the sources of anti-TSH antibodies are extrathyroid;  the factors incriminated in inducing this condition are: hereditary factors - the disease is transmitted autosomally dominant; ▪ infection; strong emotions; steroidal, gonadal hypersecretion, e. g.c.; Clinically , it is manifested by most of the signs described: ▪ gusa ▪ exophthalmia weight loss tachycardia tremors of the extremities Complementary exams : ▪ PBI-ul depăşeşte 10 mcrg%; radiodocaption is increased early; the scintigram shows diffuse hyperfixation; Thyroxine administration does not affect fixation (Werner negative test). There are several formecclassified by: - simptomatologie: with predominant neurological manifestations; ▪ with predominant muscle manifestations; with cardiac manifestations, e. g.c.;  according to etiology: family form; form associated with other autoimmune diseases; Toxic Plummer adenoma = basedowated nodular goiter: - occurs at the age of menopause; - basedowification is marked by: the appearance of permanent tachycardia weight loss  neurodegenerative signs are missing or are not obvious. - the scintigram shows: ▪ a hot hyperfixative node; the rest of the parenchyma remains scintigraphic inactive. Hyperthyroidism in men in 70% of cases, it is triggered by emotional factors. - the exophthalmia is net; - often with malignant evolution; Serious forms - with irreducible cardiotireosis Complications The most serious is acute chrysathyroid (CTA) which is manifested by: - hyperthermia (38º-39º) - burned skin - sweat - psychomotor agitation - extreme tachycardia - dyspnea - painful hepatomegaly  In the absence of treatment, the terminal basedowian coma with hyperthermia, 41.5ºC, adinamia is installed. The treatment of the crisis consists of: - continuous cooling (ice on the body, cold compresses); - sedatives (bromides); - sodium iodide in iv infusions - thyroxine administered discontinuously - betablocante.  Treatment Treatment should be differentiated: In the toxic adenoma Plummer - surgical intervention (enucleoresection or most appropriate, hemiriroidectomy); When surgical treatment is contraindicated, I131 radiodotherapy may be attempted in single administration;  In the basedowified nodular goiter the treatment is surgical: - consists of subtotal thyroidectomy; There are authors who recommend in both conditions total thyroidectomy, considering that both lesions have great malignant potential.  In Basedow's disease: a. Medical treatment is carried out with: Synthetic antithyroid (thiourea, mercaptan, aniline derivatives) - for 12-18 months; under strict clinical and biological supervision; The effects of this type of treatment, as well as the evolution of the disease as such: - aggravates exophthalmia; - give leucopenia  Healing is achieved in 40-60% of cases: - with eutiroidy; - or hypothyroidism; - but with the accentuation of neuroegetative dystonia  II. Medical treatment with iodine (Lugol solution): - requires prolonged administration with a high risk of intolerance; - allergic accidents and not infrequently resistance to treatment.  The patient must be: – in physical and mental rest for months; – isolation outside the family environment; – with a diet:  hyperprotein  hypercaloric  polyvitamine  sedatives  cardiotonice b. Radiotherapy with I 131: - gives healing in 3-9 months 75-90% There are the following risks: - malignancy - hipotiroidia - relapse or development of malignant exophthalmia  This is why it has a limited indication of the elderly: - with cachectic forms - with irreversible heart failure, e.t.c. c. surgical treatment : - consists of subtotal thyroidectomy; - causes healing in 30 days in a ratio of 75-85%; - requires preoperative training: - with rest for 15-21 days; - hypercaloric diet; - sedatives; Lugol solution is administered: in increasing doses, under control: the pulse curve, the weight curve the sleep curve;  postoperative complications lie in: - asphyxiating hematoma; - recurrent paralysis, which can lead to asphyxia; - postoperative thyroid crisis; the sequelae that may occur may be: - dysphonia; - tetanie; - hypo or hyperthyroidism