Adrenal, Thyroid, Parathyroid Glands Flashcards
reasons to operate on adrenal glands?
- primary hyperaldosteronism
- pheochromocytoma
- hypercortisolism (Cushing disease or Cushing syndrome)
- adrenocortical carcinoma
wtf is an adrenal incidentaloma?
tumor found in the adrenal gland incidentally on CT
tx? almost all surgeons agree solid incidentalomas >6cm should be removed (greater risk of developing into carcinoma)
What’s the most common cause of thyroid enlargement?
multinodular goiter
about 1% of these are malignant
What is a hot vs. cold thyroid nodule?
Hot - increased uptake of I-123=>functioning/hyperfunctioning nodule
Cold - decreased uptake of I-123
Hot nodules are virtually never malignant
Cold nodules have a chance of being/becoming malignant
HOT = GOOD (compared to cold)
What are the types of thyroid cancer?
Papillary
Follicular
Medullary
Anaplastic
What are the surgical options for thyroid cancer?
Total thyroidectomy
Unilateral lobectomy with isthusmectomy
with or without cervical node resection
What are the indications for total thyroidectomy versus lobectomy?
Total thyroidectomy is better if:
- primary tumor > 1cm
- extrathyroidal extensions or metastases
- > 5 foci
- medullary cancer
What is the general prognosis for papillary thyroid cancer?
Most patients with papillary thyroid cancer do not die of their disease
What is the general prognosis for follicular thyroid cancer?
Compared to papillary thyroid cancer, follicular thyroid cancer is more aggressive, more likely to have metastases, and has a higher mortality
What is the general prognosis for medullary thyroid cancer?
If patient is < 40yo at time of diagnosis, 10 year survival rate is 65%
If patient is > 40yo at time of diagnosis 10 year survival is 50%
What is the general prognosis for anaplastic thyroid cancer?
Bad
–very rapid course of disease progression
–poor treatment outcomes
–end of life issues and plans for comfort care measures are an integral part of initial disease management planning
What are some complications of thyroid cancer surgery?
Hypoparathyroidism
Damage to nerves - recurrent laryngeal, superior laryngeal
Bleeding
Thyrotoxic storm
Hey, did you know that medullary thyroid cancer can be inherited?
What are the indications for parathyroid surgery?
Surgery is the mainstay of treatment for parathyroid cancer.
Dx based on biopsy.
Why get biopsy/suspect cancer: hypercalcemia, neck mass, renal disease, bone disease
What are the postoperative complications of parathyroidectomy?
- Hungry bone syndrome
- Nerve damage e.g. recurrent laryngeal nerve
