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Senior - Surgery 2 > 5 - Surgical Endocrine > Flashcards

5 - Surgical Endocrine Flashcards

1
Q

Important thyroid stuff

A

Highly vascular

Zone 2 of the neck

Important surrounding structures (arteries, veins, recurrent laryngeal nerve, vagus nerve, trachea)

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2
Q

Complication of thyroid surgery

A

Thyroid storm with excessive manipulation

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3
Q

Common patient type for thyroid stuff

A

Women (most are benign)

CA risk higher if in men

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4
Q

Workup for solitary thyroid nodules

A 
H and P
Imaging  - ultrasound preferred
Tissue Dx - FNA
- Surgical Bx if suspicious 
Blood - TSH, T4, T3
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5
Q

Risk factors for malignant nodule

A

Irradiation (baby boomers given radiation txt for various conditions)

Radiation txt for Hodgkins lymphoma

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6
Q

MEN 1 (Werner’s)

A

Hyperparathyroidism (Calcium problems)

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7
Q

MEN 2a (Sipple)

A

Medullary thyroid carcinoma

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8
Q

MEN 2b

A

Ganglioneuromatosis of GI tract

Marfnaoid appearance

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9
Q

Obstructive signs include (enlarged thyroid)

A

Stridor (inspiratory)
Tracheal deviation
JVD

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10
Q

Ultrasound can help you do what with the thyroid?

A

Define the nodule

Solitary or multiple
Cystic or multinodular
Not adequate to determine benign vs malignant

Can guide the FNA - send aspirate to pathology

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11
Q

Scintigraphy?

A

Nuclear study

Can tell you if nodule is hot (hormonally active) or cold

Most nodules are cold

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12
Q

TSH low with high T3, T4 means you’ve got:

A

A functioning nodule

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13
Q

Indications for thyroid surgery

A

Suspected or proven CA on FNA

Hormonally active nodules

Functionally malignant

Recurrent cystic nodules

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14
Q

What is a follicular adenoma

A

Benign tissue hyperplasia surrounded by fibrous capsule

May be hot or cold

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15
Q

Toxic adenoma

A

Hyperfunctioning thyroid tissue

Kicking out a lot of extra thyroid hormones

Txt c iodine if < 4cm

txt c surg if > 4 cm

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16
Q

Thyroidectomy - now you need

A

Lifelong synthroid

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17
Q

Malignant thyroid nodules

A

More common in females

Papillary and follicular are most common

Medullar and anaplastic less common

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18
Q

Follicular neoplasms

A

Most are benign, but FNA cannot differentiate between benign and malignant

Requires surgery

Grab sample, look at sample, make decision based on sample

Adenoma? No further resection
Carcinoma? Cut the whole thyroid out

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19
Q

Follicular neoplasms tissue diagnosis?

A

Pathologist makes diagnosis

  • frozen section sent for immediate diagnosis
  • permanent section can be preserved in formalin for later diagnosis
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20
Q

How to determine between frozen or preserved specimen?

A

Coordinate w pathology dept

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21
Q

Papillary thyroid carcinoma is more common to:

A

Iodine deficiency, children, and post-XRT

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22
Q

Medullary thyroid carcinoma is part of which MEN syndrome?

A

MEN 2

Cut it out

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23
Q

Adjuvant therapy for thyroid CA

A

Thyroxine - replace hormone and suppress mets

Radioactive iodine - after thyroidectomy

XRT - local invasion, recurrent, mets, or unresectable

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24
Q

Thyroglossal duct cyst ?

A

Benign

Kids, young adults

Can get infected

Txt with ABX prior to elective surgery

NO I and D

25
Q

Goiter

A

Less common now thanks to iodine supplementation

Simple - euthyroid (iodine deficient)

Toxic - graves dz

26
Q

Management of goiter

A

Medical - thyroid replacement to reduce TSH stimulation to bring to euthyroid

Surgical - if refractory, airway compromise, dysphagia/odynophagia

27
Q

Surgical complications (goiter)

A

Bleeding
Injury to surrounding structures
Infection
Respiratory obstruction

28
Q

Clinical features of thyrotoxicosis

A 
Clinical	features
• Palpitations
• Diarrhea
• Irritable
• Sweating/heat	intolerance
• Menstrual	changes
• Fatigue/weight	loss • 
Physical	exam
• Tachycardia
• Ophthalmic	signs
• Tremors
• Pretibial	myxedema
29
Q

Txt for thyrotoxicosis

A

Control HR c BB’s first

Suppress thyroid function with PTU

Radioactive iodine reduces vascularity

Surgery once pt is euthyroid

30
Q

Primary care responsibilities for thyroid nodules

A

TSH / T3 / T4 / CBC / CMP

US of thyroid

CXR

Refer

31
Q

Parathyroid gland

A

4 glands embedded in the posterior lobes of the thyroid

32
Q

Primary hypercalcemia

A

Parathyroid glands excrete excess PTH

2/2 adenoma or hyperplasia

33
Q

Secondary (malignant) hypercalcemia

A

Tumors produce PTH mimicking hormone or other CA has metastasized to the bone

34
Q

If Ca is high, what do we do?

A

Order PTH

If the PTH is high, hyperparathyroidism

MC - parathyroid adenoma

35
Q

Secondary hyperparathyroidism

A

Decreased serum CA -> elevated PTH

Chronic renal failure
Malabsorption

36
Q

Clinical presentation of hyperparathyroidism

A

Stones, bones, groans, blah blah

37
Q

MEN1

A

Hyperparathyroidism

38
Q

MEN2

A

Medullary thyroid CA

39
Q

Subperiosteal bone resorption (pits) seen on CXR

A

Hyperparathyroidism

Causes increased osteoclastic activity, hence increased bone resorption

40
Q

W/U for parathyroid problems

A

CMP
PTH
Plain films (bone resorption)
US preoperatively to find offending gland

41
Q

Parathyroid gland - surgical indications

A

Renal stones
Osteoporosis
Hypercalcemic crisis

42
Q

Surgical complications of parathyroid surg

A

Bleeding
Injury to surrounding structures
Hypoparathyroidism - hypocalcemia

Tetany, Chvosteks, Trousseau, seizure

Prolonged QT onECG

Txt with Ca++

43
Q

Primary care responsibilities for hypercalcemia

A

Order CMP / PTH / CXR

Refer

44
Q

Zones of adrenal cotex

A

Zona glomerulosa - aldosterone

Zone fasiculata - cortisol

Zona reticularis - testosterone

45
Q

Medulla of cortex produces

A

Catecholamines

46
Q

What is an incidentaloma?

A

Mass discovered INCIDENTALLY during a scan

Most are benign

47
Q

Increased suspicion for malignant mass:

A

> 5cm

Mets site for breast, lung, renal, melanoma, lymphoma

Can present as adrenal failure (Adisonian crisis)

48
Q

Pheo triad

A

HA
Palpitations
Diaphoresis

49
Q

Pheo found in 50% of pts with

A

MEN2

50
Q

How do you control pheo?

A

Alpha blockade THEN beta blockade

Remember, thyroid is BB

51
Q

Adrenal cortical hyperplasia = malignant tumor of:

A

Zona fasciculata

52
Q

Pituitary adenoma - excess production of:

A

ACTH

Leads to Cushing’s disease

Surgical removal of pituitary adenoma

53
Q

Sites of ectopic ACTH production

A

Small cell CA of the lung
Carcinoid tumors
Medullar carcinoma of the thyroid

54
Q

When would you suspect sepsis-induced adrenal failure?

A

Critically ill patient that does not respond to fluid resuscitation

55
Q

If adrenal mass if hormonally active?

A

Take it out

If its a pheo - be really careful - those catecholamines will be released - be ready to alpha block

56
Q

Hormonally inactive adrenal mass

A

If encroaching on the kidney or other structures, cut it out

If it’s > 5cm, cut it out
If it’s < 5cm, reassess in 3-6 mos

57
Q

Primary care duties for adrenal mass

A 
CBC
CMP (pay attention to electrolytes)
PTH
Dexamethasone test
Urine catecholamines
Serum VMA and metanephrines

CXR to check for metastasis
Consider special imaging

refer (medicine, endo, surgery)

58
Q

What Wallace said about soldiers and thyroid disease

A

Hilarious

Senior - Surgery 2 (9 decks)

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