Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

REGUB > 21. Thyroid And Parathyroid Surgery > Flashcards

21. Thyroid And Parathyroid Surgery Flashcards

1
Q

Describe iodine deficiency.

7

A
  1. Essential trace element
  2. Remote inland areas
  3. Enlargement of gland
  4. “Endemic goitre”
  5. Iodized table salt
  6. Milk / cheese / eggs / fish
  7. RDA 150ug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is hyperthyroidism?

What diseases is it seen in?
(4)

What are the symptoms?
(10)

What are the signs?
(6)

What are the investigations?
(2)

What is the treatment?
(3)

A

Hyperthyroidism: decrease TSH, increase T3 + T4

  1. Grave’s Disease
  2. Toxic adenoma
  3. Toxic multi nodular goitre
  4. Amiodarone / Post-Parton thyroditis

SYMPTOMS

  1. Excessive sweating
  2. Heat intolerance
  3. Increased bowel movements
  4. Nervousness, agitation, anxiety
  5. Weight loss
  6. Fatigue/weakness
  7. Decreased Concentration
  8. Irregular periods
  9. Palpitations, Increase BMR
  10. Gynaecomastia
SIGNS
1.	Tremor/ Sweating
2.	Arrhythmias
3.	Thin skin
4.	Thinning of hair
5.	Goitre (not always but possible)
6.	In Graves Disease: 
          —> Thyroid Achropachy
          —> Exophthalmus
          —> Lid Lag
          —> Ophthalmoplegia

INVESTIGATIONS

  1. Thyroid function test (TSH, thyroxine - T4)
  2. Thyroid antibodies

TREATMENT

  1. Carbimazole or Propylthiouracil (PTU)
    a. Generally used for 12-24 mths
    b. Long-term remission of 30%
    c. Remission rates of 15% - 80% after cessation
    d. SE: agranulocytosis
2.	Radioactive Iodine Treatment (RAI)
A. Advantages: 
- 75% cure at 2-3 months
- Repeated for 25% who don’t respond
- 90% cure rate
- Easily tolerated
- Inexpensive

B. Disadvantages

  • Hypothyroidism
  • Pregnancy
  • Breastfeeding
  • Young patients
  • Low RAI uptake
  • Radiation thyroiditis
  • Cancer risk
  1. Surgery
    a. RAI contraindicated
    b. Obstructive/large toxic goitre
    c. Patient choice
    d. Single Toxic Adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Grave’s Disease?

What is the general clinical presentation?
(4)

What are the symptoms?
(2)

What are the signs?
(1)

What are the investigations?
(6)

What is the treatment?
Medical (4)
Surgery (2)

A
  • Autoimmune disorder - production of antibodies that stimulate TSH receptor
  • CP: hyperthyroidism, goitre, thyroid eye signs, pretibial /localized myoedema
  • Most common in women 20-40

SYMPTOMS

  1. Extremities
    - Acropachy
    - Onycholysis
    - Pretibial myxoedema
  2. Thyroid eye disease
    - Proptosis/exophthalmos
    - Periorbital edema
    - Conjunctival injection
    - Ophthalmoplegia

SIGNS
1. Smooth, diffusely enlarge goitre with bruit

INVESTIGATIONS

  1. High FT4
  2. Low TSH
  3. TSH receptor antibodies positive
  4. TPO antibodies positive in up to 80%
  5. Thyroglobulin antibodies positive in up to 70%
  6. Scintigraphy will demonstrate increased uptake
TX
A) Medical 
1.	Beta blocker for symptoms
2.	Carbimazole
3.	Propylthiouracil (PTU)
4.	Radioactive iodine

B) Surgical

  1. Thyroidectomy
  2. Subtotal thyroidectomy
    - Patient should be euthyroid prior to surgery to decrease vascularity of gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is thyroid storm?

What are the causes?
(7)

What are the treatment?
(8)

A
  • Acute, life threatening hyper metabolic state induced by excessive thyroid hormone release

CAUSES

  1. Sepsis
  2. Surgery
  3. Anaesthesia
  4. Radioactive Iodine
  5. Drugs (salicylates/NSAIDS)
  6. DKA
  7. Direct trauma

TX

  1. Resuscitation
  2. Ice/paracetamol
  3. Electrolytes/arrhythmias
  4. Anti-adrenergics
  5. High dose PTU
  6. Iodine Compounds
  7. Glucocorticoids
  8. Surgery (1 week)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a solitary nodule?

What investigations are performed? Explain.
3

A
  • Discrete thryoid lesion that causes enlarged nodes and hoarseness
  • Occurs in 4-8% of population
  • 8017% excised nodules are malignant (>1cm require work - up)

INVESTIGATIONS

  1. Ultrasound (+/- FNAC)
    - If <1cm, most likely no need for FNAC (Fine Needle Aspiration Cytology)
    - If >/= 1cm or suspicious for malignancy, should have FNAC
    - FNAC will show if malignant cells are present
    - Doesn’t show architecture but Core Biopsy is pretty risky in thyroid
    - If FNAC does not demonstrate malignancy in a suspicious lesion, repeat in 6 months
    - If there is still no evidence of disease, the malignancy is unlikely
    - Follicular cells are worrisome – 25% will have underlying malignancy
  2. Nuclear imaging called scintigraphy: assist with diagnosis
    - “Hot” nodules = technetium uptake = no cancer
    - “Cold” lesions = no technetium uptake = 10% chance of malignancy
  3. CT neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are complications of thyroid surgery?

6

A
  1. Hypo-parathyroidism
  2. Recurrent Laryngeal Nerve Damage
  3. Haemorrhage / Haematoma
  4. Infection
  5. Recurrence
  6. Thyroid Storm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 4 types of thyroid cancer?

A
  1. Papillary (80%)
  2. Follicular (10%
  3. Medullary (<5%)
  4. Anaplastic (1-2%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain papillary thyroid cancer.

What is the treatment?
(2)

What is the management?
(6)

A
  • Commonest type (80%)
  • Children and adults
  • Slow growing tumour
  • Regional lymph node metastasis
  • Multifocal in origin
  • Tx: total thyroidectomy and LN dissection
  • L-thyroxine to suppress TSH post-op is required in all patients
  • Prognosis: excellent

MANAGMENT

  1. < 1 cm = Lobectomy
  2. > 1 cm = Thyroidectomy
  3. Central Neck (VI) Dissection
  4. Lateral Neck Dissection
  5. RAI Ablation
  6. Lifelong Eltroxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe follicular thyroid cancer.

What is the treatment?
(2)

What is the management?
(3)

A
  • 10% of thyroid malignancies
  • Well differentiated tumour
  • Occur in older age group than papillary
  • Slow growing tumour
  • Metastasis (haematogenous) to lungs and bones mainly
  • Prognosis: depend on extent of vascular invasion 90% to 30% 10 -year survival

TX

  1. Thyroid lobectomy (without metastasis)
  2. Total thyroidectomy + radioactive iodine (with metastasis)

MANAGEMENT

  1. > 1 cm = Thyroidectomy
  2. RAI Ablation
  3. Lifelong Eltroxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe medullary thyroid cancer.

A
  • Cells secrete calcitonin (tumour marker)
  • Uncommon (< 5% of thyroid malignancies)
  • More common in females in 6th decade of life
  • Slow growing
  • Arises from parafollicular cells of the thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe anaplastic thyroid cancer.

A
  • <3% of all thyroid malignancies
  • Commonly in elderly females
  • Aggressive and rapid growth
    —> Pressure symptoms (oesophagus & trachea)
    —> Laryngeal nerve paralysis
  • Complete resection not possible
  • Chemo & radiotherapy not very effective
  • Mets to LN, lungs, bone
  • Prognosis: v poor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is thryoid lymphoma?

Is it common?

A
  • Uncommon
  • A/w Hashimoto’s thryoidits
  • Occurs in 5th decade
  • Very responsive to chemo-radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe parathyroid disease.

Physiology (2)

Pathology (1)

Aetiology (2)

S+S (5)

Types (3)

Investigations (2)

Management (1)

A 
PHYSIOLOGY
1. Parathyroid Hormone (PTH)
o	Secreted by the Chief cells 
o	Levels are inversely controlled by [Ca2+ ]
2. Effects:
o	Tubular reabsorption of Ca2+  
o	Osteoclastic resorption of bone
o	Intestinal absorption of Ca2+ 
o	Synthesis of 1-25DHCC (active Vit. D)
o	Excretion of phosphate

PATHOLOGY

  1. Hyperparathyroidism
    - F:M = 2:1
    - Mild / asymptomatic

AETIOLOGY

  1. Primary> PTH, normal or Ca 2+
    - Adenoma: 90%
    - Hyperplasia: 10%
    - Carcinoma: < 0.1%
  2. Secondary: PTH appropriate to low Ca 2+
    - Chronic Renal Failure
    - Vitamin D Deficiency

S+S

  1. Bones: bone pain, arthralgia
  2. Renal: stones, polyuria
  3. GI: pain, DU, pancreatitis
  4. Neuro: depression, apathy
  5. Cardiac: hypertension, heart block
TYPES
1.	Primary: adenoma (1 gland)
•	80-85% = Adenoma
•	10-15% = Hyperplasia
•	1% = Carcinoma
•	Bipolar Disorders
•	Lithium treatment (20%)
•	Thiazide diuretics
  1. Secondary: chronic renal failure
  2. Tertiary: hyperplasia of glands due to chronic secondary hyperparathyroidism

INVESTIGATIONS

  1. Sestanimini Scan (gold standard)
    - Absorbed by hyper functioning glands
    - 80% of adenomas
    - Frequently negative
    - 91% specificity
    - Allows intra-op Gamma probe confirmation
  2. U/S

MANAGEMENT
1. Unilateral parathyroidectomy (revolutionized adenoma surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly

REGUB (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions