36 - Thyroid Flashcards
Which nerves innervate the thyroid?
Vagus
- superior laryngeal nerve
- recurrent (inferior laryngeal nerve)
Which branch of the superior laryngeal nerve gives sensory innervation to the larynx and vocal cord?
internal
What may happen when the external branch of the superior laryngeal nerve is damaged?
dysphonia- decreased voice volume
Damage to the recurrent laryngeal nerve may cause: 3
vocal cord paralysis
ineffective cough/aspiration
airway obstruction if bilateral
Which arteries supply the thyroid? 4
2 superior thyroid from the external carotid
2 inferior thyroid artery from the subclavian artery
Which of the arteries supplying the thyroid, supply the parathyroid as well?
inferior thyroid artery
Which veins drain the thyroid? 3
superior thyroid vein -> internal jugular vein
middle thyroid vein
inferior thyroid vein ->innominate & brachiocephalic
Which cells make up the thyroid? which hormones do they produce?
follicular- T4/3
parafollicular (C cells)- calcitonin
Describe the interaction between T3/4 and TRH/TSH:
T3/4 inhibit TSH and TRH- T3 is more potent
Describe the interaction between dopamine/cortisol/somatostatin and TSH:
dopamine/cortisol/somatostatin inhibit TSH secretion from the hypophysis
Serum thyroglobulin will be __ in thyrotoxicosis and __.
elevated
malignancy
TPO antibodies suggest __/__.
Graves/Hashimoto
Calcitonin is elevated in __ or __.
MEN2
medullary carcinoma
Iodine mapping is used when we find a __ + __ TSH.
Warm= __hormones, usually __ and do not require __.
Cold=__ hormones, may be __.
nodule decreased secreting benign FNA no carcinogenic
Warm mapping may suggest: 5
graves (homogenic) toxic adenoma (focal) toxic multi nodular goiter (multiple) Hashitoxicosis TSH producing pituitary tumor
Cold mapping may suggest: 4
subacute thyroiditis
iodine induced hyperthyroidism
thyroxine overdose (no radiation)
malignancy (decreased radiation)
US may reveal nodules > _ mm. We can differentiate between __ and __.
3
benign
malignant
Thyroid function tests: euthyroid-\_\_ subclinical hypothyroidism-\_\_ overt hypothyroidism-\_\_ subclinical hyperthyroidism-\_\_ overt hyperthyroidism-\_\_
- euthyroid- normal TSG, T3/4
- subclinical hypothyroidism- elevated TSH, normal T3/4
- overt hypothyroidism-elevated TSH, decreased T3/4
- subclinical hyperthyroidism- decreased TSH, normal T3/4
- overt hyperthyroidism- decreased TSH, elevated T3/4
What are the risk factors for thyroid malignancy? 6
- age (<30 , >60)
- men
- pre-exposure to iodine/radiation
- family Hx (MEN2, familial medullary carcinoma, PTC, Gardner syndrome, Cowden syndrome)
- normal thyroid function
- fast growing/rigid/hard/irregular characteristics
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