Thyroid and Parathyroid

structures. Fibrosis may involve the strap muscles, blood vessels, trachea, esophagus,
and, on occasion, the parathyroid glands, which leads to hypoparathyroidism. Severe
cases can result in the patient's becoming hypothyroid. The cause of the condition is
unknown, but it may be part of a more generalized condition known as fibrosclerosis
that causes fibrosis in other parts of the body, including the retroperitoneum,
.( mediastinum, lacrimal glands, and bile ducts (sclerosing cholangitis
Patients usually present with symptoms of compression such as hoarseness, stridor,
and dyspnea. In more progressive cases involving the esophagus, dysphagia may be
present. There often is rapid enlargement of the thyroid gland, which on palpation is
. “woody,” hard, and nontender. Laboratory investigations usually are normal
Riedel's thyroiditis resembles anaplastic thyroid cancer, except that the goiter is
smaller. Diagnosis usually is established by FNAC, although open biopsy
occasionally is needed. Treatment with tamoxifen and steroids often is helpful.
Isthmectomy to relieve compressive symptoms or to establish the diagnosis is
necessary in some patients. Most operations are difficult because of the loss of tissue
planes and should only be embarked on by experienced surgeons. Thyroxine
. replacement therapy is necessary in patients with hypothyroidism
Acute Suppurative Thyroiditis
Acute suppurative thyroiditis is rare. It is predominantly a disease of childhood or
adolescence and is invariably associated with an acute upper respiratory tract
infection. The disease is manifested by acute thyroid pain associated with dysphagia,
fever, and, occasionally, rigors. The most common bacterial causative agents are
streptococci, staphylococci, and pneumococci, but it also can be caused by
. Escherichia coli and Coccidioides immitis
Suppuration usually is unilateral but may extend into the deep spaces in the neck,
invading the trachea, esophagus, or mediastinum. FNAC with smear and culture is
diagnostic. Treatment consists of intravenous antibiotics and drainage of any abscess.
Thyroid lobectomy rarely is required. Most patients recover completely and are
. euthyroid
GOITER
Simple or nontoxic goiter is an enlargement of the thyroid gland in a euthyroid
patient, not associated with any neoplastic or inflammatory process. It may be diffuse
. and symmetrical or nodular. Several forms of goiter have been described
Familial Goiter
Familial goiters usually are regarded as goiters caused by an inherited enzymatic
defect (dyshormonogenesis) that may cause impairment of iodine accumulation,
organification, or coupling of iodotyrosine in the thyroid gland. The inborn error of
metabolism generally is inherited as an autosomal recessive trait, but dominant traits
have been described. Familial goiters usually are associated with hypothyroidism,
although patients may remain euthyroid. Familial goiter also is associated with
.( deafness (Pendred's syndrome
Endemic Goiter
Endemic goiter is defined as thyroid enlargement affecting a significant number of
inhabitants of a particular locale. The most important factor in the development of this