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ABDOMEN 4 > 2.2 Thyroid-Benign/Malignancy > Flashcards

2.2 Thyroid-Benign/Malignancy Flashcards

1
Q

Benign FOCAL thyroid disease includes (3)

A

Cysts
Thyroglossal Dust Cysts
Adenomas

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2
Q

True cysts are rare (that you’re born with)

Most cysts are caused by?

A

follicular adenoma (benign solid tumor) undergo degeneration and become more cystic in appearance.

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3
Q

These cysts can be due to blunt trauma or acute hemorrhage of adenoma

A

Hemorrhagic cysts

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4
Q

What types of cysts may you see (3)

Which one is unique to thyroid cysts?

A

Simple
Complex
Colloid (unique to thyroid) ** gelatinous material

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5
Q

What is the sonographic appearance of a colloid cyst

A

cystic lesion, single or multiple foci, with comet tail artifact.

can be large with multiple (many comet tail artifacts)

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6
Q

What is a congenital abnormality related to the thyroid gland?

A

Thyroglossal Duct cyst

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7
Q

Thyroglossal Duct cyst is located?

A

Midline neck, anterior to trachea, superior to isthmus

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8
Q

Why is a Thyroglossal Duct cyst formed?

A

Failure of tract to atrophy (base of tongue to isthmus)

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9
Q

Thyroglossal Duct cyst sonographically

A

Fusiform cystic structure less than 3 cm in size

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10
Q

What is a benign solid neoplasm with a capsule located in the neck?

A

Adenoma

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11
Q

WHAT IS THE MOST COMMON TYPE ADENOMA

A

Follicular Adenoma

can’t determined based on ultrasound

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12
Q

What are the features of adenomas (5)

A 
slow growing
variable in size
can compress adjacent tissue
Asymptomatic
Cold nodule on Nuc med scan
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13
Q

Sonographic feature of adenomas (6)

A 
Range of echogenicity (anechoic, iso, hyper)
Solitarty
Defined
Round/Oval
Hypoechoic halo
Eggshell calcification
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14
Q

What is an eggshell calcification?

A

calcs that surround periphery

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15
Q

WHAT ARE THE 2 Benign Diffuse Diseases?

A

Inflammation (thyroiditis)
Hyperplasia (goiter)

*Diagnosis based on clinical and lab findings

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16
Q

What is inflammation of the Thyroid and S&S?

A

Thyroiditits

Swelling, pain fever

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17
Q

The inflammatory conditions are most common in?

A

Middle aged women

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18
Q

WHAT ARE THE 5 FORMS OF THYROIDITIS

A
  1. Hashimoto’s (chronic lymphocytic)
  2. Acute Suppurative
  3. Subacute Granulomatous (De Quervain)
  4. Silent (painless)
  5. Invasive Fibrous (Reidels)
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19
Q

What is the most common form of ADULT hypothyroidism?

A

Hashimoto’s (chronic lymphocytic)***

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20
Q

Hashimotos is a inflammatory disease typically painless, more common in women and is an autoimmune disorder meaning it produces ?

A

Anti thyroid antibodies

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21
Q

Patients with a Hx of Hashimotos have an increased risk of developing ?

A

lymphoma of the thyroid gland

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22
Q

Hashimotos sonographically (5)

A

Diffusely enlarged, Heterogenous, Hypoechoic
Thyroid gland
Possible discrete calcs
Acute = hypervascular
But usually normal or decreased
Cervical lymphadenopathy (enlarged lymph nodes in the neck)

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23
Q

Hashimoto’s is difficult to differentiate from

A

MNG (multinodular goiter)

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24
Q

Rare thyroiditis more common in children?

A

Acute Suppurative Thyroiditis

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25
Q

Describe Acute Suppurative Thyroiditis S & S

and What type of infection is it?

A

Firm PAINFUL thyroid
Fever and Sore throat

BACTERIAL INFECTION

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26
Q

Sonographically Acute Suppurative Thyroiditis (3)

A

Enlarges thyroid gland
Hypoechoic
Possible abscess (walled off collections of fluid and debris, looking like complex masses)

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27
Q

What is the thyroiditis where the glands swell rapidly and are very painful and tender

A

Subacute Granulomatous Thyroiditis

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28
Q

Subacute Granulomatous Thyroiditis other name?

A

De Quervain***

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29
Q

What type of infection is Subacute Granulomatous Thyroiditis

A

VIRAL INFECTION

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30
Q

The initial stages of Subacute Granulomatous Thyroiditis presents as

A

hyperthyroid

rarely progress to hypothyroid

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31
Q

Does Subacute Granulomatous Thyroiditis need surgery or will it go away on own?

A

remits spontaneously (goes away on own)

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32
Q

What is the sonographic appearance of Subacute Granulomatous Thyroiditis

A

Enlarged
Hypoechoic
Normally decreased vascularity

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33
Q

What is the thyroiditis that is enlarges with NO pain

A

Silent thyroiditis

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34
Q

Sonographically Silent thyroiditis resembles

A

Hashimotos

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35
Q

Clinically Silent thyroiditis resembles

A

Subacute granulomatous

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36
Q

What is the rarest form of thyroiditis?

A

Invasive Fibrous Thyroiditis

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37
Q

What is the other name for Invasive Fibrous Thyroiditis

A

Riedel’s Struma

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38
Q

Invasive Fibrous Thyroiditis can result in ?

A

complete destruction of the thyroid gland

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39
Q

Sonographically Invasive Fibrous Thyroiditis

A

Enlarged
Heterogeneous
Can extend extrathyroid (into soft tissue surrounding thyroid gland)

40
Q

Hyperplasia is known as a?

41
Q

Hyperplasia is described as ?

A

Diffuse enlargement
+/- functional disturbances (hyper, hypo etc)
Palpable gland

42
Q

Causes of Hyperplasia (2)

A

Iodine deficiency

Defect in normal hormone synthesis

43
Q

Does hyperplasia happen fast or slow

A

Slow, years to manifest

44
Q

WHAT ARE THE 3 TYPES OF HYPERPLASIA (GOITER)

A

Grave’s disease
Nontoxic goiter
Multinodular goiter

45
Q

What is a diffuse toxic goiter (thyrotoxicosis)

means produces excess thyroid hormone (hyperthyroidism)

A

Grave’s Disease

46
Q

Is Graves Disease an autoimmune disorder?

A

Yes

body will produce thyroid antibodies

47
Q

Is this condition common?

When it presents who do you see it in?

A

YES

more common in women 30-40 years of age

48
Q

What are the signs and symptoms of Graves

A

Exophthalmos (bulging eyes)
Skin thickening
clubbed toes and fingers

49
Q

Sonographically Graves disease appears as

A 
Diffuse symmetrical enlargement 
Lobulated
Homogeneous or heterogeneous
Hypoechoic
Color "thyroid inferno" Hyper-vascular
50
Q

What hyperplasia (goiter) grows slowly and is due to lack of iodine

A

Non-Toxic Goiter

51
Q

Non toxic goiter can be ____ or ____ and causes ___ functional disturbances

A

Endemic or Sporadic

No

52
Q

Sonographically Non toxic goiter

A

Diffusely and uniformly enlarged

Smooth or nodular echo texture

53
Q

What goiter is more common in females ages 50-70? with low iodine

A

Multinodular Goiter

54
Q

What is larger the Multinodular goiter or the Non toxic goiter ?

A

Multinodular

55
Q

Multinodular are

56
Q

low Iodine= thyroid hormone production. So thyroid release more ___ from pituitary, making thyroid gland enlarge and overtime develop____

A

TSH; nodules

57
Q

Sonographically Multinodular Goiter

A 
Enlarged thyroid gland
Asymmetrical (MAKING THIS different)
diffusely heterogeneous
multiple discrete nodules
Calcs
Cystic areas
Cold nodule
58
Q

MALIGNANT LESIONS

59
Q

Malignant lesions are more common in ____ ages ____

A

women; 40-60

60
Q

Which are more worrisome, solitary or multiple nodules?

61
Q

Thyroid cancer is typically ___ growing

62
Q

__% of Nuc med cold nodules are malignant

63
Q

There is no sonographic feature that is sensitive enough to detect cancer of thyroid so what is needed?

A

FNA (fine needle aspiration)

64
Q

Patients with thyroid cancer may present with (3)

A

Pressure symtoms - Swallow or breathing problems
PAINLESS,palpable neck
Hoarseness

65
Q

What COULD be the sonographic appearance of malignancy in the thyroid? (6)

A 
Hypoehcoic
poorly defined jagged boarders
absence of a halo (benign adenomas often have hypoechoic halo)
microcalcs
Taller than Wide (AP bigger than width)
Enlarged nodes
66
Q

Specific Thyroid Cancers include these (6)

A 
Papillary 
Follicular
Medullary
Anaplastic 
Lymphoma 
Metastases
67
Q

THE MOST COMMON AND LEAST AGGRESSIVE MALIGNANCY

A

PAPILLARY CARCINOMA*

60-70%

68
Q

Papillary are more common in females and are ___growing may spread to ______ and are _____.

A

Slow;Cervical lymph nodes; Asymptomatic

69
Q

Sonographically Papillary Carcinoma (6)

A 
Solid
Hypoechoic mass  (hypoechoic halo)
May have micro calcs
Mass can be tiny up to 10 cm
Hypervascularity 
can have irregular boarders
70
Q

What is the SECOND most common type of thyroid malignancy?

A

Follicular Carinoma*

15-20%

71
Q

Follicular carcinoma is still slow growing but more____ than Papillary

A

Aggressive

can metastases to bone via the blood

72
Q

What is there a hx of with follicular carcinoma?

73
Q

What demographic is follicular carcinoma more common in, gender and age?

A

women

40-50

74
Q

Sonographically The Follicular carcinoma is similar to?

A

Benign adenoma

75
Q

Therefore, what is the appearance of the follicular carcinoma?

A

Enlarged, encapsulating nodule

BUT HAS
irregular boarders
thick halo
microcalcs

76
Q

This carcinoma is a hard bulky mass and only 5% of the carcinomas

A

Medullary Carcinoma

77
Q

Medullary Carcinoma is more common in men or women?

A

BOTH equally (all other is more common in women)

78
Q

Medullary Carcinoma secretes

A

secretes calcitonin (regulates blood calcium)

79
Q

What is medullary carcinoma associated with

A

pheochromocytoma tumors (adrena gland)

80
Q

What is the sonographic appearance of medullary carcinoma? (5)

A 
Solid
Hypoechoic
Well-Circumscribed
Encapsulated
****Coarse calcifications
81
Q

What is the rarest and most aggressive carcinoma

A

Anaplastic Carcinoma

82
Q

What patient age is Anaplastic most common in?

A

Older > 60 years

83
Q

With Anaplastic carcinoma death often occurs from

A

Compression/asphyxiation

CCA, Jugular, Trachea, esophagus etc.

84
Q

Sonographic appearance of Anaplastic carcinoma? (5)

A 
Hypo
solid
Irregular
Encase or invade blood vessels
Invade neck muscles
85
Q

PRIMARY _____ is most often ______

A

Lymphoma; Non-Hodgkins

86
Q

Primary lymphoma is present more in older females and grows______

87
Q

Primary lymphoma has a hx with

A

Hashimoto’s

88
Q

Primary lymphoma appears sonographically as

A

Hypo, lobular, non vascular

89
Q

_____ to the thyroid gland is infrequent. If it does occur is occurs through _____ from____, ___,__ and __

A

Metastases
hematogenous route, through the blood supply.
from breast, lung colon or melanoma

90
Q

About __% of pateints with systemic lymphoma have thyroid involvement.

91
Q

LIST BENIGN FEATURES of thyroid lesions

A

Regular, well defined boarders
Thin, hypoechoic halo
Solitary or multiple minute cysts within mass
Hyperechoic
Large calcs, especially around the periphery (eggshell)

92
Q

LIST MALIGNANT FEATURES of thyroid lesions

A

Irregular boarders
Absence of halo
Microcalcs (other than meduallary carcinoma LARGE)

93
Q

REVIEW QUESTIONS *may repeat

94
Q

What is the most common thyroid carcinoma?

A

Papillary carcinoma (60-70%) most treatable

95
Q

What is the most aggressive thyroid carcinoma

A

Anaplastic Carcinoma (invades other structures)

96
Q

Which diffuse thyroid process causes hyperthyroidism?

A

Graves (toxic goiter)

97
Q

What is the most common worldwide cause of multinodular goiter

A

Iodine deficiency

ABDOMEN 4 (10 decks)

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