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Chandrasekaran's approach for thyromegaly
Iodine is not the solution for all Thyroid problems
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  What is McArthy Thyroid Clinic?

McArthy Thyroid Clinic is an exclusive thyroid Clinic where you can have all investigations related to thyroid under one roof & also you can get the opinion of a senior consultant in the management of thyroid disorders.

  What does it offer?

It offers the following:

1. Thyroid Hormone Profile (T3, T4, TSH & Thyroid antibodies),
2. Ultrasonogram of Neck,
3. Fine Needle Aspiration Cytology (FNAC) of the Goitre with or without ultrasound guidance.
4. Complete physical examination by an operating physician, highly qualified in the management of thyroid disorders.

  How is it done?

McArthy Thyroid Clinic functions between 9 am & 9 p.m. on all days except sundays. Blood investigations are done between 9 am & 9pm. Ultrasonogram and FNAC are done between 5pm & 9pm. Patients will be reviewed with the investigation results on another day. During the review detailed explanations of problems and advice on treatment will be given.

  What are the benefits?

It is comprehensive and specific for thyroid. No special preparation is needed. Above all, you will get the opinion of a thyroid specialist. Remember, all at affordable cost under one roof.

What you ought to know about your thyroid.
  What is a Goitre?

Goitre is an enlargement of the thyroid Gland, which is situated in front of the neck.

  What are the common problems encountered in the Thyroid gland?

The gland may function more (Hyper) or less (Hypo) than necessary.
It may simply become bigger and bigger.
It may turn cancerous

  Can it affect children?

Yes, In fact, it can affect all age groups.
Exact cause may vary. This has to be investigated.

  Can I have a normal hormone level and yet have a goitre?

Yes, it is possible. A goitre with normal thyroid hormone level will not respond to medical management (thyroxin supplementation). Cancer of thyroid should be ruled out in all these cases.

  Why should I undergo the test called FNAC?

Only FNAC will answer three important questions.

1. Whether your Goitre will respond to medical management or not?
2. Whether there is cancer in your thyroid or not?
3. If you need surgery, what type of surgery to be performed? Hence FNAC is a must.

  Why should I undergo ultrasonogram of neck?

IOnly large nodules in the thyroid are palpable. Small nodules may not be palpable. Sometimes patient can have small nodules in one lobe of thyroid in addition to the large nodule on the other lobe. This can be detected only by ultrasonogram.

Presence of small nodules on the opposite lobe alters the line of surgical management. In addition ultrsonogram can detect small enlarged lymph nodes in the Neck. In such cases we can do Ultrasound guided FNAC of the lymph node to rule out Cancer.

Hence Ultrasonogram is a must for all patients with goitre.

  Is thyroid surgery a major operation?

Yes. It is a major operation. It needs general anaesthesia. Type of surgery depends on the type of problem. One can lead a perfectly normal life after thyroid surgery even though some may require hormone replacement.

  If I need surgery what should I do?

If you need surgery you will have to undergo complete preoperative investigations. Our physician & Anaesthesiologist will examine you with the investigation report and give their opinion. In case if you have any medical problem, they will treat it before submitting you for surgical correction.

  How long should I be hospitalised?

Usually less than five days.

  Is surgery the only remedy for goitre?

No, some goitres will regress with thyroxine supplementation..

  Can Iodised salt solve my problem?

It depends on the cause of the goitre.

  Autoimmune Thyroiditis - How to Diagnose and
How Long to Treat?

Majority of patients in the age group of 12 to 25 years attending the out patient clinic of the Department of Endocrine Surgery, Government General Hospital,Chennai ( a tertiary care Hospital in South India) are suffering from Thyroiditis. Most of these patients seek medical aid when they develop a diffuse goiter. Some of them presented with palpitation and tremors without thyromegaly but the majority of patients presented with diffuse goiter in Hypothyroid state.

Investigations done to confirm the diagnosis: (1) FT3,FT4,TSH (2)Thyroid antibodies: Antimicrosomal antibody (TPO) and Anti thyroglobulin antibody(ATG) and (3) Fine Needle Aspiration Cytology.

Thyroiditis is confirmed by positive Antimicrosomal Antibody titre (AMA). All Thyroiditis patients with diffuse goitre had elevated serum TSH with decreased FT3 & FT4 confirming Hypothyroid status.Hence,they were all treated with thryoxine 50 to 100mcg OD. Patients who presented with palpitation and tremors had elevated FT3 & FT4 associated with decreased TSH confirming that they were in the toxic phase of thyroiditis.Hence, those patients were treated with beta blocker propranolol.

AntiThyroglobulin antibody titre was used to differentiate Toxic phase of thyroiditis from Graves' disease. Toxic phase of thyroiditis is due to increased liberation of stored hormone in to the system, due to follicular damage and not due to increased production of thyroid hormone.Patients in toxic phase of thyroiditis developed severe hypothyroidism when treated with antithyroid drug carbimazole for a few weeks.

FNAC is a very useful investigation to confirm Thyroiditis. Cytology revealed Lymphocytic infiltration in all patients with thyroidtis.

AMA(TPO) titre became negative in most of our patients over a period of 12 to 18 months. Hence the treatment was given for the same period. Negative AMA(TPO) titre is an indication to withdraw the medical treatment.

Article Source: http://EzineArticles.com/?expert=Maharajan_Chandrasekaran

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