SU22.1-3 | Thyroid Anatomy, Physiology and Swellings — Summary & Reflection

KEY TAKEAWAYS

A thyroid swelling moves on swallowing; a thyroglossal cyst also moves on tongue protrusion. The history (growth rate, pressure and voice symptoms, thyroid status, risk factors) and a reproducible inspect–palpate-from-behind–assess-nodes-and-status examination separate the benign from the worrying. Surgically, the gland's danger lies in its neighbours: the superior thyroid artery with the external laryngeal nerve, the inferior thyroid artery with the recurrent laryngeal nerve, and the parathyroids. Goitre is classified as diffuse, nodular or neoplastic. A solitary nodule is worked up in a fixed order — TSH → ultrasound → FNAC reported by Bethesda. Thyroid cancers are distinct: papillary (commonest, lymphatic, excellent prognosis), follicular (haematogenous, needs histology), medullary (C-cell, calcitonin, MEN-2), anaplastic (elderly, lethal). Surgery ranges from hemithyroidectomy to total thyroidectomy, defined by preserving the laryngeal nerves and parathyroids; consent for nerve palsy, hypocalcaemia and reactionary haemorrhage.

REFLECT

Recall a patient you have examined with a neck lump, or imagine clerking one in your next clinic. Did you elicit movement on swallowing and on tongue protrusion, palpate from behind, and check the nodes and thyroid status — and did you document it cleanly enough that another clinician could follow your findings? Now consider the work-up: would you have requested TSH, ultrasound and FNAC in the right order, and could you explain to the patient why a hoarse voice or a rapidly growing hard lump changes the urgency? Reflect on how mastering the gland's anatomy would change the way you consent a patient for thyroidectomy.