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SURGERY > DISORDERS OF THE THYROID GLAND > Flashcards

DISORDERS OF THE THYROID GLAND Flashcards

1
Q

Persistence of the THYROGLOSSAL DUCT along its migratory path
1 % will have malignancy - PAPILLARY THYROID CA

A

thyroglossal duct cyst

SISTRUNK OPERATION - excision of the entire cyst and central hyoid bone

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2
Q

Ectopic thyroid tissue located in the BASE OF TONGUE

FAILURE OF DESCENT of the THYROID ANLAGE

A

Lingual Thyroid

exogenous thyroid hormone - suppress TSH
RAI ablation then hormone replacement

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3
Q

Normal thyroid tissue found in the other compartments of the neck

A

Ectopic Thyroid

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4
Q

Maldevelopment an obstruction of lymphatic system
Sequestrations of lymphatic tissue develops which does NOT communicate with the lymphatic system

soft, compressible, non tender masses - LATERAL or POSTERIOR triangle of the neck

A

Cystic Hygroma

MRI - imaging modality

intralesional injection of a sclerosing agent (OK-432, Bleomycin)
COMPLETE SURGICAL RESECTION - preferred treatment with preservation of all vital neural and vascular structures

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5
Q

Staging of the Neck

A

N0 - no regional lymph node metastasis
N1 - metastasis in single ipsilateral node < 3 cm
N2a - metastasis in a SINGLE ipsilateral lymph node b/w 3-6 cm
N2b - metastasis in a MULTIPLE ipsilateral lymph node, < 6 cm
N2c - metastasis in a MULTIPLE ipsilateral lymph node, > 6 cm
N3 - metastasis in a lymph node > 6 cm

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6
Q

removes levels I to V cervical lymphatics, spinal accessory nerve, IJV and SCM

A

Radical Neck Dissection

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7
Q

Removes the SAME levels of cervical lymphatics as in RND BUT PRESERVES the spinal accessory nerve, IJV, SCM

A

Modified Radical Neck Dissection (Functional Neck Dissection)

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8
Q

Preserves lymphatic structures normally removed in an RND or MRND

A

Selective Neck Dissection

Supraomohyoid (I, II and III)
for ORAL CAVITY malignancies

Lateral Neck Dissection (II, III, IV)
for LARYNGEAL malignancies

Posterolateral Neck Dissection (II, III, IV and V)
for THYROID malignancies

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9
Q

MC benign salivary gland tumor

A

Pleomorphic adenoma

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10
Q

MC malignant salivary gland tumor

A

Mucoepidermoid Ca

Adult - 2nd MC -adenoid cystic ca - w/ propensity for
distant mets

Children - 2nd MC - acinic cell ca

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11
Q

Most important use if for monitoring of differentiated thyroid cancer recurrence after total thyroidectomy and RAI ablation

A

Serum Thyroglobulin

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12
Q

Sensitive marker for medullary thyroid cancer

A

Serum Calcitonin

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13
Q

LOW dose radiation (12-24 hrs half life)

for imaging thyroid tissues - lingual, ectopic metastatic

A

Iodine 123

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14
Q

HIGHER radiation - 8-10 days half life)

screen and treat differentiated thyroid cancers - papillary and follicular ca

A

Iodine 131

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15
Q

WHO Classification of Thyroid Size

A

GRADE I - no palpable or visible goiter
GRADE 2 - palpable goiter, NOT VISIBLE in NORMAL head position
GRADE 3 - palpable goiter, VISIBLE in NORMAL head position

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16
Q

Some Indications for THYROIDECTOMY

A

confirmed cancer or suspicious thyroid nodules
severe reactions to antithyroid medications
large goiters w/ compressive symptoms
reluctant to undergo RAI

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17
Q

Initial test that must be requested in the evaluation of thyroid nodules

A

Serum TSH

if euthyroid or hypothyroid — FNAB
if hyperthyroid — RAI scan

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18
Q

For detecting NON PALPABLE thyroid nodules, differentiating SOLID vs CYSTIC and identifying CERVICAL LYMPHADENOPATHIES

A

Thyroid Ultrasound

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19
Q

Most useful for LARGE, FIXED, SUBSTERNAL goiters and evaluation of LUNG METASTASES

A

CT Scan

20
Q

For evaluation of EXTRATHYROIDAL TUMOR EXTENSION - hoarsenss, dysphagia, stridor, cough

A

MRI

21
Q

Provides anatomic and physiologic information

A

Iodine Scan

hot or warm lesion - increased activity (< 5 % risk of malignancy)
cold lesion - traps less iodine than surrounding gland (20 % risk of malignancy)

22
Q

Used to screen malignancies when other imaging studies are negative

A

Positron Emission Tomogram (PET) scan

23
Q

Single most important test in evaluation of thyroid nodules

A

Fine Needle Aspiration Biopsy (FNAB)

at least 6 follicles w/ at least 10-15 cells from at least 2 aspirates

24
Q

Features suggesting MALIGNANCY in a THYROID NODULE

A

Ultrasound of the Thyroid

hypoechogenecity
microcalcifications
irregular or blurred nodule margins
increased nodular blood flow
evidence of tumor invasion or regional lymph node metastases
25
Q

Features suggesting MALIGNANCY in a CERVICAL LYMPH NODE

A

Ultrasound of the Thyroid

complex echo pattern or irregular hyperechoic small intranodular structures
irregular diffuse intranodular blood flow
Solbiati index (ratio of largest to smallest diameteer of a node = 1 - lymph node is more round than long
26
Q

MC thyroid cancer

A

Papillary carcinoma

prior history of EXTERNAL RADIATIONS

Orphan Annie Nuclei
Psammoma bodies

cervical lymph nodes - site of metastasis
27
Q

Treatment for Papillary Carcinoma

A

High risk tumors/ bilateral - TT or NTT

< 1 cm, low risk, no hx of irradiation, no evident metastases - thyroid lobectomy

advanced tumors (T3 or T4) - neck dissection

28
Q

Usually solitary and encapsulated lesions

A

Follicular carcinoma

iodine deficient areas
cervical lymphadenopathy - uncommon
CANNOT be diagnosed by FNAB
(+) vascular and capsular invasion
29
Q

Treatment for follicular neoplasm

A

Adenoma - thyroid lobectomy

Carcinoma - total thyroidectomy

30
Q

Subtype of follicular carcinoma

multifocal and bilateral

A

Hurtle Cell Carcinoma

from OXYPHIL cells
neck - common metastatic area
31
Q

Arises from PARAFOLLICULAR cells at the SUPEROLATERAL lobes of thyroid gland

A

Medullary Thyroid Carcinoma

>50% - bilateral
cervical lymphadenopathy
produces CALCITONIN, CEA, CGRP, HISTAMINIDASE, SEROTONIN
associated w/:
	MEN 2A: MTC, pheochromocytoma, primary HPT
	MEN 2B: MTC, pheochromocytoma, Marfanoid habitus, mucocutaneous 			ganglioneuromatosis
32
Q

Treatment for Medullary Carcinoma

A

Total Thyroidectomy w/ Bilateral Central Neck Node Dissection

33
Q

1 % o all thyroid malignancies; HIGHLY AGGRESSIVE tumor

A

Anaplastic carcinoma

giant and multinucleated cell - FNAB	
lymph node metastases
34
Q

Treatment for Anaplastic Carcinoma

A

mostly palliative
TT or NTT
En Bloc resection if w/ extrathyroidal extension
adjuvant radiotherapy w/ or w/o chemotherapy

35
Q

Postoperative Complications w/n 24 hrs of Thyroid Surgery

A

Hypocalcemia
Dyspnea
Dystonia

36
Q

MC malignancy that metastasize to thyroid

A

Renal Carcinoma

37
Q

Salivary Gland Tumors Risk of Malignancy

A

Sublingual - 100%
Submandibular - 50%
Parotid - 20%

38
Q

75% of all salivary gland tumors occur in

A

Parotid Gland

39
Q

MC location of SUPERNUMERARY GLANDS

A

Thymus

OTHER LOCATIONS:
	w/n the parenchyma of thyroid glands
	tracheoesophageal groove
	mediastinum
	anywhere along the neck
40
Q

MC location of ECTOPIC PARATHYROID

A

Paraesophageal

41
Q

Increased PTH from abnormal parathyroid glands

Etiology:
parathyroid adenoma
parathyroid hyperplasia
parathyroid carcinoma

A

Primary Hyperparathyroidism

	kidney stones
	painful bones
	abdominal groans
	psychic moans
	fatigue overtones
increase serum Ca
increase intact PTH or 2 site PTH levels
decrease serum phosphate
elevated 24 hr urine Ca
42
Q

Treatment for Primary Hyperparathyroidism

A

Parathyroidectomy

43
Q

Increased PTH in response to hypocalcemic states (chronic renal failure, inadequate calcium intake, gut malabsorption)

A

Secondary Hyperparathyroidism

Calciphylaxis - painful violaceous lesions on the extremities that may necrose and become
	gangrenous leading sepsis and death
44
Q

Treatment for Secondary Hyperparathyroidism

A

Phosphate binding antacids
Cinacalcet (calcimimetic)
Oral calcium and vitamin D

for uncontrolled symptoms - 3.5 parathyroidectomy or total parathyroidectomy
+ autotransplantation

45
Q

Persistent hyperparathyroidism and hypercalcemia following successful renal transplant or resolution of underlying

A

Tertiary Hyperparathyroidism

d.t. irreversible parathyroid gland hyperplasia w/ autonomous PTH production
46
Q

MCC is thyroid surgery

DiGeorge syndrome - congenital absence of parathyroid gland

A

Hypoparathyroidism

tingling sensation on fingertips and around lips

Chvostek sign - tapping on the facial nerve anterior to ear causes contraction of ipsilateral
	facial muscles
Trousseau sign -carpopedal spasm after occlusion of blood to the forearm

Tetany (worst case)
47
Q

Treatment for Hypoparathyroidism

A

Calcium (IV gluconate)

Vitamin D supplementation

SURGERY (27 decks)

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