1/7. Thyroid imaging.Four modalities are being used to image the thyroid gland: (1) scintigraphy ("scanning"), employing one of several currently available radiopharmaceuticals, (2) ultrasound (US), (3) computed tomography (CT, "CAT" scan), and (4) magnetic resonance imaging (MRI). The first method, scintigraphy, provides an image of the spatial distribution of thyroid functional attributes, the nature of which are dependent on the interaction between the particular radiopharmaceutical employed and the tissue in question, whereas the latter three modalities provide an image of the spatial distribution of structural attributes such as the varying degrees of echogenicity of the tissues examined or the differential tissue attenuation of an x-ray beam, which permits visualization of the structures. A fifth modality, fluorescent thyroid scanning, in which fluorescence of the iodide within the thyroid gland is induced by low-dose external radiation and which gives an image of iodine distribution, is generally unavailable and only rarely used. For most patients, the combination of careful history, skilled physical examination, tests of thyroid function (and serum thyroglobulin and calcitonin for cancer evaluation), fine needle aspiration biopsy, and scintigraphy provide the most cost-effective means of evaluating the thyroid gland and its diseases. Of the four modalities currently used to image the thyroid gland--scintigraphy, ultrasound, computerized tomography, and magnetic resonance imaging--only scintigraphy has the widest application. It is employed to determine gland size, locate thyroid tissue, evaluate nodules and masses, determine the cause of a painful tender gland, differentiate various forms of goiter, detect differentiated thyroid carcinoma and gland remnants, assess suppressibility or stimulatability of the gland, and identify nonfunctioning cancers. ultrasonography, computed tomography, and magnetic resonance imaging are not useful in differentiating between benign and malignant nodules, and their sensitivity in detecting impalpable nodules is not clinically useful, because nodules less than 1 to 1.5 cm in diameter are only rarely clinically significant. These modalities have limited utility in the evaluation of the thyroid gland: they are useful in sizing known lesions and for the detection of cervical lymphadenopathy in thyroid cancer cases.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/7. actinomycosis abscess of the thyroid gland.OBJECTIVES: To present an unusual case of actinomycosis abscess of the thyroid gland as well as review the history, etiology, pathogenicity and treatment of actinomycosis infections of the head and neck. STUDY DESIGN: Case study. methods: A report of a 39 year-old female status post tooth extraction that developed an actinomycosis abscess of the thyroid. RESULTS: After a thyroid actinomycosis abscess was suggested by physical exam, ultrasound, CT scan and needle aspiration, an otolaryngology consult was obtained. The patient successfully was managed with thyroidectomy and intravenous ceftriaxone. CONCLUSIONS: Although actinomycosis soft tissue infections of the head and neck are relatively uncommon, the head and neck surgeon must include it in the differential diagnosis when clinical presentation raises suspicion. Early biopsy is necessary for appropriate identification of the organism with the appearance of sulfur granules lending a clue to the diagnosis. debridement and/or excision are often necessary for antibiotics to be used successfully. Antimicrobial therapy should be used for six to twelve months to completely eradicate the disease and prevent recurrence.- - - - - - - - - - ranking = 0.047613194767566keywords = physical (Clic here for more details about this article) |
3/7. Itch: a symptom of occult disease.BACKGROUND: pruritus, (the Latin word for itch), is defined as the 'desire to scratch'. It is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life. OBJECTIVE: This article summarises the systemic causes of pruritus, describes the assessment of a patient presenting with itch without dermatological cause, and discusses the management of itch in patients with cancer. DISCUSSION: patients with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease. Causes of systemic pruritus include cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, hodgkin disease, and hiv. A thorough history and a complete physical examination are central to the evaluation of pruritus. In the absence of skin lesions, diagnostic testing is directed by the clinical evaluation and may include a complete blood count, liver function tests, serum creatinine, blood urea nitrogen levels, measurement of thyroid stimulating hormone, and chest X-ray. Removal of the causative agent and appropriate investigation and treatment of the underlying disease are essential first line measures in the treatment of pruritus.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/7. The thyroid gland and the dental practitioner.The thyroid gland has an important function in almost every aspect of human physiology. As well, its location in the neck allows for easy evaluation by the dentist. Part I of this paper reviews the normal functions of the thyroid gland as well as systemic effects caused by abnormal function. This is supplemented by easily-acquired methods of physical examination of the thyroid gland suitable for the dental practitioner. Part II is a case report highlighting the potential adverse effects of dental treatment of a patient who had poorly controlled thyroid function following total thyroidectomy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/7. Fine needle biopsy and scintigram in the preoperative diagnosis of thyroid lesions.Fine needle biopsies (FNB) of the thyroid were examined from 860 patients. In 703 cases follicular cells without atypia were found and in this group of patients the clinical diagnosis was nodular goitre. Operations were performed in 138 patients and in 97 cases the cytological finding could be correlated to the histopathological diagnosis. In 33 of these patients thyroid carcinoma was histologically verified. In 26 of the carcinoma cases cytologic examination showed grave atypia or changes indicating carcinoma. The cases in which the cytological diagnoses were falsely negative are discussed. Moderate cellular atypia occurred in one case with papillary carcinoma. In two cases the cytological examination gave a false positive diagnosis of cancer, both representing thyroiditis of the lymphoid type. The scintigrams in patients with thyroid carcinoma are also presented. Cold nodules were found in 10/19 patients and a hot nodule in .1 patient. In 3 patients the scintigrams were normal and in another 5 inconclusive. The results indicate that thyroid scintigrams can only be used as a supplement to the physical examination and a guidance for FNB. The contribution of FNB in the decision to operate is discussed and it is concluded that FNB is a valuable adjunct in preoperative diagnosis of thyroid lesions. The best diagnostic results are obtained when there is a close cooperation between clinician, radiologist, cytologist and pathologist.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/7. Cervical lipomas masquerading as thyroid nodules.Masses in the thyroid gland can usually be distinguished from other anterior cervical masses by history, physical examination, and scintigraphic and ultrasonographic examination. We describe four cases of lipomas masquerading as thyroid nodules in which finding from these examinations were consistent with solid thyroid nodules. Computed tomography can distinguish fat from thyroid tissue density, thus avoiding the use of thyroid hormone suppression or the need for urgent surgery.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/7. Inappropriate thyroid gland ablation in patients with generalized resistance to thyroid hormone. A common sequela of a rare disorder.Generalized resistance to thyroid hormone is one of several rare disorders of thyroid metabolism that can be associated with confusing symptoms and signs. Five cases of generalized resistance to thyroid hormone that were misdiagnosed with thyrotoxicosis, leading to unnecessary thyroid gland ablation and iatrogenic hypothyroidism, are reviewed herein. These cases illustrate the point that a careful review of the history, physical examination, and laboratory data, as well as an understanding of hormonal feedback relationships, will greatly benefit the practitioner in evaluating the patients with thyroid dysfunction. Consultation with an endocrinologist may be helpful to establish the correct diagnosis and avoid unnecessary treatments.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |