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Drafts of absite from online deck > ABSITE Review - Thyroid > Flashcards

ABSITE Review - Thyroid Flashcards

1
Q

What is the blood supply to the parathyroid glands?

A

Inferior thyroid artery from the thyrocervical trunk

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2
Q

What is the venous drainage of the thyroid galnd?

A

Superior and Middle thyroid veins to IJ vein

Inferior thyroid vein to innominate vein

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3
Q

What are the signs of superior laryngeal nerve injury?

A

Loss of projection and easy voice fatigability (opera singers)

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4
Q

Where the recurrent laryngeal nerve loops in both sides?

A

Left RLN loops around aortic arch; Right RLN loops around right subclavian (or innominate artery)

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5
Q

What are the signs of superior laryngeal nerve injury?

A

Injury results in hoarseness; bilateral injury can obstruct airway –> needs emergency tracheostomy

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6
Q

Which RLN is most likely to be nonrecurrent?

A

Right RLN 2-3%

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7
Q

What is the function of thyroglobulin?

A

Store T3 and T4 in colloid

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8
Q

What is the next step for posthyroidectomy stridor?

A

Open neck and remove hematoma emergently –> can result in airway compromise

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9
Q

What is the Wolff-Chaikoff effect?

A

Patients given high doses of iodine (Lugol’s solution, potassium iodide), which inhibits TSH action on thyroid and inhibits organic coupling of iodide, resulting in less T3 and T4 release

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10
Q

What is the work up needed for an asymptomatic thyroid nodule?

A

1st - TSH - if elevated, give thyroxine; if not elevaed, proceed with FNA

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11
Q

What are the possible results and next step of FNA?

A

Shows follicular cells –> thyroidectomy or lobectomy (5-10% malignancy risk)
Shows thyroid CA –> thyroidectomy or lobectomy
Shows cyst fluid –> drain fluid, if it recurs –> thyroidectomy or lobectomy
Shows colloid tissue –> likely colloid goiter, treat with thyroxine or surgery if it enlarges
Indeterminant (10-25%) –> repeat FNA

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12
Q

T/F: Thyroid nodules are more common in females and 85% are benign.

A

TRUE

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13
Q

What is the MCC of goiter?

A

Iodine deficiency

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14
Q

What is the usual finding and treatment for a thyroglossal duct cyst?

A

Classically moves upward with swallowing

Tx - need to take midportion or all of the hyoid bone along with the cyst

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15
Q

What are the two drugs used for hyperthyroidism treatment?

A

PTU and methimazole

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16
Q

What is the MOA and side effects of PTU?

A

MOA - Inhibits peroxidases and prevents DIT and MIT coupling

SEs - aplastic anemia or agranulocytosis (rare)

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17
Q

What is the MOA and side effects of methimazole?

A

MOA - Inhibits peroxidases and prevents DIT and MIT coupling

SEs - cretinism in newborns (crosses placenta), aplastic anemia or agranulocytosis (rare)”

18
Q

When is more safe to do a thyroidectomy in a pregnant patient?

A

2nd trimester

19
Q

What is the MCC of hyperthyroidism and symptoms?

A

Graves’ disease
Sxs - exophthalmos, pretibial edema, atrial fibrillation, heart dysfunction, heat intolerance, thirst, increase appetite, weight loss, sweating, palpitations

20
Q

What is the cause of Graves’ disease?

A

Caused by IgG antibodies to TSH receptor

21
Q

What is the preop preparation needed for Graves’ disease?

A

PTU or methimazole until euthyroid, beta-blocker, 1 week before surgery, Lugol’s solution for 10-15 days to decrease friability and vascularity (start only after euthyroid)

22
Q

What is the MCC of hypothyroidism in adults?

A

Hashimoto’s disease

23
Q

What is the cause of Hashimoto’s thyroiditis?

A

Both humeral and cell-mediated autoimmune disease (microsomal and thyroglobulin antibodies)

24
Q

What is ssen in pathology in Hashimoto’s thyroiditis?

A

Lymphocytic infiltrate

25
Q

What are the usual symptoms and diagnostic findings of De Quervain’s thyroiditis?

A

Viral URI, tender thyroid, sore throat, mass, weakness, fatigue
Elevated ESR

26
Q

What is Riedel’s fibrous struma and what it is associated with?

A

Woody, fibrous component that can involve adjacent strap muscles and carotid sheath
Can resemble thyroid cancer or lymphoma (need biopsy)
Associated with sclerosing cholangitis, fibrotic diseases, retroperitoneal fibrosis

27
Q

What facts are worrisome for thyroid malignancy?

A

Solid, solitary, cold, slow growing, hard, male, age >50, previous neck XRT, MEN IIa or IIb

28
Q

What is the MC thyroid cancer? What is the main risk factor?

A

Papillary thyroid carcinoma (80-90%)

Risk Factors - childhood radiation, older age (worst prognosis)

29
Q

The papillary thyroid cancer spreads to …

A

lymphatics

30
Q

What are the pathologic findings of papillary thyroid cancer?

A

Psammoma bodies (calcium) and Orphan Annie nuclei

31
Q

When is radioactive iodine needed after surgery?

A

Metastatic disease, residual local disease, positive lymph nodes or capsular invasion

32
Q

What is important about thyroid replacement and radioactive iodine therapy?

A

Do not give thyroid replacement until after treatment because it will suppress uptake

33
Q

How the follicular thyroid cancer spreads? Where it goes most commonly?

A

Hematogenously - most commonly to bone.

34
Q

Which cancer is most aggressive - Follicular or Papillary?

A

Follicular

35
Q

Which syndrome is medullary thyroid carcinama associated with?

A

MEN IIA & IIB

36
Q

From which cells, the medullary thyroid carcinama arises from?

A

Parafollicular cells

37
Q

What is seen in the pathology of medullary thyroid carcinoma?

A

Amyloid deposition

38
Q

What is the treatment of choice for medullary thyroid cancer?

A

Total Thyroidectomy and central neck dissection

39
Q

When is a prophylactic thyroidectomy needed?

A

Prophylactic thyroidectomy and central node dissection in MEN Iia or Iib patients at age 2

40
Q

What is the most aggressive thyroid cancer?

A

Anaplastic thyroid carcinoma, rapidly lethal

41
Q

When is the best time for radioactive iodine therapy?

A

4-6 weeks after thyroidectomy - TSH levels are th highest

Drafts of absite from online deck (62 decks)

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