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SON131-Abd 2 > Chapter 22 Thyroid > Flashcards

Chapter 22 Thyroid Flashcards

1
Q

The thyroid is part of what system?

A

endocrine system

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2
Q

What is the thyroid function?

A

it maintains metabolism, growth, and development.

Also, it produces, stores, and secretes thyroid hormones

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3
Q

What are the 3 main thyroid hormones?

A

T4, T3, Calcitonin

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4
Q

Where is the thyroid located?

A

Located in the anterorinferior neck at the level of the thyroid cartilage

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5
Q

What connects the two lobes of the thyroid?

A

isthmus

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6
Q

What is bounded laterally to the thyroid?

A

Bound laterally by the carotid artery and jugular vein

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7
Q

The size and shape of the thyroid gland varies with what?

A

gender, age, and body surface area

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8
Q

What small percentage of population has this superior from the isthmus?

A

pyramidal lobe

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9
Q

What is the size of the thyroid for adults?

A

Length- 40-60mm (4-6cm)
AP- 20-30mm (2-3cm)
Width- 15-20mm (1.5-2cm)

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10
Q

What is the size of the thyroid for children?

A

Length- 20-30mm (2-3cm)
AP- 12-15mm (1.2-1.5cm)
Width- 10-15mm (1-1.5cm)

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11
Q

What is the size of the isthmus?

A

4-6mm

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12
Q

What lies anterolateral to the thyroid?

A

Muscles- Strap muscles- sternothyroid, omohyoid, and sternohyoid
Muscles- Sternocleidomastoid muscles

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13
Q

What lies posterolateral to the thyroid?

A

Carotid artery, jugular vein, and vagus nerve

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14
Q

What lies medial to the thyroid?

A

Larynx
Trachea
Esophagus-may be to the left of midline
Posterior border of each lobe has superior and inferior parathyroid glands

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15
Q

Blood supplies by how many arteries?

A

4

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16
Q

from where do the two superior thyroid arteries arise from?

A

Two superior thyroid arteries arise from external carotid artery (ECA) and descend to the upper poles

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17
Q

From where do the two inferior thyroid arteries arise from?

A

Two inferior thyroid arteries arise from the thyrocervical trunk of the subclavian artery and ascend to the lower thyroid poles

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18
Q

Where do the thyroid veins drain into?

A

Corresponding veins drain into the internal jugular veins.

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19
Q

what is the mechanism for producing thyroid hormones?

A

iodine metabolism

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20
Q

How is T3 and T4 produced?

A

The thyroid traps iodine from the blood and, through chemical reactions produces T3 and T4 (stored in colloid of the gland)

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21
Q

When the body needs thyroid hormone , it is released into the bloodstream by the action of what?

A

When the body needs thyroid hormone , it is released into the bloodstream by the action of thyrotropin also known as thyroid-stimulating hormone (TSH)

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22
Q

What is TSH produced by?

A

pituitary gland and hypothalamus

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23
Q

What does calcitonin decrease?

A

the concentration of calcium in the blood

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24
Q

What does euthyroid mean>

A

When the thyroid is producing the correct amount of thyroid hormone
This is a normal state

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25
Q

Define hypothyroidism

A

undersecretion of thyroid hormone

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26
Q

What are the causes of hypothyroidism?

A

Low intake of iodine (goiter) in the body
Inability of the thyroid to produce adequate amount of the thyroid hormone
A pituitary gland that does not control the thyroid production

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27
Q

Clinical signs and symptoms for hypothyroidism

A 
Myxedema-swelling and thickening of the skin
Weight gain*
Hair loss*
Increased subcutaneous tissue around the eyes
Lethargy-no energy, tired*
Intellectual and motor slowing
Cold intolerance
Constipation
Deep husky voice*
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28
Q

define hyperthyroidism

A

oversecretion of thyroid hormone

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29
Q

what are causes of hyperthyroididm?

A

Occurs when the entire gland is out of control or when a localized neoplasm (adenoma) that causes overproduction of the thyroid hormone

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30
Q

What does hyperthyroidism increase?

A

dramatically increases metabolic rate

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31
Q

What are the clinical signs for hyperthyroidism?

A 
Weight loss*
Increased appetite
High amount of nervous energy
Tremor
Excessive sweating*
Heat intolerance*
Palpitations*
Exophthalmos (Protruding eyes)
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32
Q

What is important to obtain with the patient?

A

Obtain pertinent patient history
General health
Use of thyroid medication or history of use
Previous imaging of thyroid
Family hx. Of hyperparathyroidism or thyroid cancer
History of radiation or surgery to the neck

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33
Q

What is the most common cause of thyroid disorders?

A

iodine deficiency

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34
Q

what does iodine deficiency lead to?

A

goiter formation and hypothyroididm

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35
Q

What are some nodular thyroid diseases?

A 
Nontoxic simple goiter
Toxic multinodular goiter
Grave’s disease
Thyroiditis
Benign Lesion
Cyst
 Adenoma
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36
Q

Define goiter

A

Enlargement of the thyroid gland that is often visible as an anterior protrusion of the neck.

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37
Q

When a goiter enlarges what can happen?

A

May become very large, compressing the esophagus and interfering with swallowing, or it can put pressure on the trachea

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38
Q

What are some characteristics of a goiter?

A

May be diffuse and symmetrical or irregular and nodular

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39
Q

What are some causes of goiters?

A

Graves’ disease
Thyroiditis
Neoplasm
Cyst

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40
Q

Sonographic findings of a goiter?

A

Enlarged, nodular and appearance may vary
Overall heterogeneous thyroid
Isoechoic to hyperechoic nodules
Thin peripheral halo as a result of perinodular blood vessels and edema
Fibrosis and calcifications may develop
Ultrasound is used to determine the location and characteristics of the masses

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41
Q

describe cysts in thyroid

A

Cyst-thought to be cystic degeneration of a follicular adenoma
Anechoic-serous or colloid fluid
Echogenic or moving fluid-hemorrhage

42
Q

describe adenoma

A

Adenoma-follicular adenoma is benign and characterized by complete fibrous encapsulation.

43
Q

Adenomas are more common in who?

A

females

44
Q

describe adenomas

A

Range from anechoic to echogenic
Commonly have peripheral halo
Halo may be a result of edema of compressed thyroid tissue or capsule of the adenoma.

45
Q

describe malignant lesions

A

Rare
The ultrasound appearance is variable- size, single vs. multiple, solid, largely cystic or complex
The risk of malignancy decreases with multiple nodules

46
Q

What is an indication for malignancy?

A

Solitary nodule with cervical adenopathy on the same side suggest malignancy

47
Q

What is present in thyroid carcimonas 50-80%?

A

calcifications

48
Q

what are the types of malignant lesions?

A 
Papillary
Follicular
Medullary
Anaplastic
Lymphoma
49
Q

What is the most common thyroid carcinoma?

A

papillary carcinoma

50
Q

How does papillary carcinoma spread through?

A

spreads through the lympathics

51
Q

What are ultrasound findings of papillary carcimona?

A

25% cases have round laminated calcifications
20% will have cervical lymphadenopathy
Ultrasound Findings
90% hypoechoic
Microcalcification with or without shadowing
90% hypervascular

52
Q

What are the two types of follicular carcinoma?

A

Two types- minimally invasive and widely invasive

Usually solitary

53
Q

True or false- follicular carcinoma is more aggressive than papillary

A

true

54
Q

how does the follicular carcinoma spread by?

A

Spreads through bloodstream rather than lymphatics

55
Q

Ultrasound findings of follicular carcinoma

A

Irregular margin with thick irregular halo
Nodular enlargement
Tortuous internal blood vessel

56
Q

Where can mets spread to?

A

bone, lung, brain, and liver

57
Q

What accounts for 5% of thyroid cancers?

A

medullary carcinoma

58
Q

ultrasound findings of medullary carcinoma

A

Ultrasound findings
Similar to papillary ca.- hypoechoic
Calcium deposits are often noted
Careful evaluation of the entire neck are and liver to rule out metastases

59
Q

What does medullary carcinoma have a high incidence in?

A

High incidence in metastatic involvement of lymph nodes

60
Q

a characteristics of medullary carcinoma

A

Often familial- 20% of the time

May be multicentered and/or bilateral in familial cases

61
Q

What accounts for less than 2% of carcinoma?

A

anaplastic carcinoma

62
Q

characteristics of anaplastic carcinoma

A

Usually occurs after age 50
Hard fixed mass with rapid growth
Growth is locally invasive in surrounding neck structures
It usually causes death by compression and asphyxiation due to invasion of the trachea

63
Q

ultrasound findings of anaplastic carcinoma

A

Hypoechoic

Invasion of surrounding muscles and vessels

64
Q

Lymphoma in the thyroid is usually what type

A

non-Hodgkin

65
Q

Lymphoma clinically is ?

A

rapid growing neck mass

66
Q

What are preexisting cases for patients with lymphoma?

A

Many cases patient has preexisting chronic lymphocytic thyroiditis (Hashimoto’s disease) or hypothyroidism

67
Q

ultrasound findings of lymphoma

A 
Nonvascular
Hypoechoic
Lobulated
Thyroid tissue may be heterogeneous because of associated thyroiditis
Can have areas of cystic necrosis
68
Q

define diffuse thyroid disease

A

Generally causes diffuse enlargement of the gland without palpable nodules

69
Q

conditions that cause diffuse enlargement

A

Graves/ disease
Thyroiditis
Colloid or adenomatous goiter

70
Q

how is diffuse thyroid disease diagnosis made?

A

Diagnosis is made on the basis of clinical and lab findings

71
Q

define thyroiditis

A

Swelling and tenderness of the thyroid

72
Q

What is thyroiditis caused by

A

Caused by infection or related to autoimmune abnormalities

73
Q

What are types of thyrioditis

A

Acute suppurative
Subacute (de Quervain’s)
Chronic lymphocytic (Hashimoto’s disease)

74
Q

What is the most common type of thyroiditis?

A

hashimotos thyroiditis

75
Q

what is hashimotos thyroiditis

A

Characterized by destructive autoimmune disorder, which leads to chronic inflammation of thyroid
Young or middle age female
Painless and diffuse enlargement

76
Q

ultrasound findings of hashimotos

A

Coarse and slightly more hypoechoic

Initially homogenous enlargement occurs with nodularity then progresses to inhomogeneous enlargement.

77
Q

What can hashimotos develop into

A

hypothyroidism

78
Q

what is graves disease

A

More frequently in women over 30 and related to autoimmune disorder
Characterized by thyrotoxicosis and is the most frequent cause of hyperthyroidism

79
Q

What are findings of graves disease

A

Findings- hypermetabolism, diffuse toxic goiter, exophthalmos, and cutaneous manifestations

80
Q

appearance of graves disease

A

Thyroid gland is diffusely homogeneous and enlarged

81
Q

What is thyrotoxix crisis or thyroid storm

A

acute situation with uncontrolled hyperthyroidism-usually extremely vascular
Usually precipitated by infection or surgery
May be life threatening- hyperthermia, tachycardia, heart failure, and delirium

82
Q

what is the most common number for parathyroid

A

4 but some have 3-5

83
Q

parathyroid are most commonly paired how?

A

Most commonly paired- 2 posterior to superior pole and the other 2 posterior to inferior pole

84
Q

describe how parathyroid looks like

A

Flat disk shaped
Echo texture similar to thyroid tissue
Normal size 4mm and not seen on ultrasound
Occasionally a single gland can be seen as a flat hypoechoic mass posterior and adjacent to the thyroid
Glands > 5mm can be seen as an elongated hypoechoic mass between the posterior longus colli and anterior thyroid lobe

85
Q

What is parathyroid lab data

A

Calcium sensing organs in the body
Produces parathyroid hormone (PTH) and monitor serum calcium feedback mechanism
Patients with unexplained hypercalcemia are the most common referrals for parathyroid sonography.

86
Q

what can be done to detect inferior parathyroid glands

A

have the patient swallow in realtime

87
Q

What is primary hyperparathyroidism

A

Increase in function
Women two to three times more likely than men
Particularly common after menopause

88
Q

what is primary hyperparathyroidism characterized by

A

Characterized by- hypercalcemia, hypercalcuiria and low serum levels of phosphate (hypophosphatasia)

89
Q

true or false patients are most asymptomatic at the time of diagnosis for primary hyperparathyroidism

A

true

90
Q

what are manifestations for primary hyperparathyriodism

A

Manifestations are nephrolithiasis and osteopenia

91
Q

when does primary hyperparathyriodisn occur

A

Occurs when PTH is increased by adenoma, primary hyperplasia, or, rarely, carcinoma of the parathyroid

92
Q

characterics of primary hyperplasia

A

10% of primary hyperparathyroidism cases
Hyperfunction of all parathyroid glands with no apparent cause
Rarely > 1cm
Hyperplasia may or may not involve all glands

93
Q

what is the most common cause of primary hyperparathyroidism (80%)

A

adeoma

94
Q

what is the most common shape of adenoma

A

Most common shape is oval, hypoechoic

Benign usually

95
Q

primary hyperparathyroidism carcinoma

A

Differentiation between adenoma and cancer is difficult
Mets to regional nodes or distant organs, capsular invasion or local recurrence must be present for cancer to be diagnosed
Most- small, irregular, firm mass

96
Q

define secondary hyperparathyroidism

A

Chronic hypocalcemia
Usually all four glands are involved
The abnormalities listed below induce PTH secretion leading to secondary hyperparathyroidism

97
Q

what are the causes of secondary hyperparathyroidism

A

Renal failure
Vitamin D deficiency (rickets)
Malabsorption syndromes

98
Q

define thyroglossal duct cyst

A

Thyroglossal Duct Cyst
congenital midline of neck anterior to trachea.
Oval or spherical masses rarely larger than 2 or 3cm

99
Q

define bracial cleft cysts

A

Brachial Cleft Cyst

Usually lateral to thyroid gland

100
Q

define abscess

A

Can occur in any location in the neck

Most common low level echoes with irregular walls. Can be anechoic to echogenic

101
Q

define Lymphadenopathy

A

Enlargement of lymph nodes or lymph vessels

SON131-Abd 2 (4 decks)

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