The document discusses the thyroid gland and thyroid disorders. It notes that the thyroid is butterfly shaped and larger in women, especially during pregnancy. It attaches to the trachea via Berry's ligament. Hyperthyroidism is characterized by low TSH while hypothyroidism shows high TSH. Reflexes are brisk in hyperthyroidism and "hung up" in hypothyroidism. Both conditions can cause proximal myopathy. Rare complications of Graves' disease include pretibial myxedema and Riedel's thyroiditis.

2. Butterfly shaped organ
Larger in woman (increases in
size in pregnancy)
Berry’s ligament  attaches
thyroid to trachea (moves on
swallowing)
Almost
always 4cm
below larynx

3. HYPERthyroidism  Low TSH
HYPOthyroidism  High TSH
Thyrotropin releasing hormone
Thyroid stimulating hormone

6. Talley and O’Connor
Chapter 28 pg 451

7. Approx. 1/3 of
hypothyroid pts

8. Pulse  Sinus tachy/AF
Myxoedema causes thickening
of carpal tunnel
Reflexes in hyperthyroid  Brisk
Reflexes in hypothyroid  “Hung up”
Prox myopathy in both conditions

10. • Hypothyroidism: Thickened, cool, dry skin. Alopecia,
vitiligo, periorbital oedema, xanthelasmata, check
tongue for swelling.
Exopthalmos only in Grave’s
(NB  T&O’C Pg 450)
Complications of exophthalmos: chemosis
(conjunctival oedema), conjunctivitis, corneal
ulceration, optic atrophy, ophthalmoplegia.
Myxoedema deposition behind
eye  exopthalmos

12. Pretib myxoedema  bilateral firm, elevated
dermal nodules/plaques. Pink, brown or skin
coloured. Caused by mucopolysaccharide
accumulation. Only in Graves’ disease and NOT
hypothyroidism

13. Talley and O’Connor
Chapter 28 pg 448 and 451
Super helpful questions to remember to
ask a pt on Hx taking if you are
suspecting thyroid disease!!
(More on that during Endo Hx)

15. Rare!

16. NB! 80% of pts with goitre are
biochemically euthyroid, 10% are
hypothyroid and 10% are hyperthyroid.

18. This is very NB!
Students are often
confused by this!
Swallowing also allows
the SHAPE of the gland
to be seen better

19. Thyroglossal cyst:
• Midline mass
• Can present at any age
• Embryological remnant of the thyroglossal duct.
Cystic hygroma:
• fluid-filled sac
• Results from blockage in the lymphatic
system
Pharyngeal pouch:
• typically in pts >70 y/o1
• Present with dysphagia, regurg, chest
infections, aspiration, halitosis and LoW.
Branchial cleft cyst:
• congenital epithelial cysts
• arise on lat. part of neck from failure of obliteration of 2nd branchial cleft in embryonic
development.
• account for almost 20% of neck masses in children

20. Riedel’s thyroiditis (RT)  RARE, chronic inflam. disease of thyroid characterized by
dense fibrosis that replaces normal thyroid parenchyma. Fibrotic process invades
adjacent structures of the neck and extends beyond the thyroid capsule.