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Gen Surgery > Disorders Of The Thyroid Gland > Flashcards

Disorders Of The Thyroid Gland Flashcards

1
Q

What is a symmetrical enlargement of the thyroid called

A

Goitre

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2
Q

Name of an asymmetrical enlargement because of focal pathology in an otherwise normal lobe

A

Solitary nodule

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3
Q

What is characteristic of the neck swelling caused by thyroid enlargement

A

Occurs in the lower midline of the neck and moves readily on swallowing

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4
Q

Causes of midline enlargement of the neck

A
  • thyroid enlargement
  • submental lymphadenopathy
  • thyroglossal duct
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5
Q

Causes of lateral neck swelling

A
  • cervical lymphadenopathy (most common)
  • salivary gland enlargement
  • branchial cyst
  • cystic hygroma
  • pharyngeal pouch
  • carotid body tumour
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6
Q

Causes of a goitre

A
  • physiological: puberty (both sexes), pregnancy and lactation
  • simple, non nodular goitre: iodine deficiency (endemic and sporadic)
  • multinodular goitre
  • thyroiditis: autoimmune, hashimotos, de quervain thyroiditis, riedel thyroiditis
  • thyroid carcinoma
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7
Q

Causes of a multinodular goitre

A
  • genetic: familial goitre, Pendred Syndrome

- Goitrogens: anti- thyroid drugs, PAS, sulphonylureas, iodine containing medications, cobalt

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8
Q

When should multinodular goitre be investigated

A

When malignancy has to be excluded as in the case of a single nodule or when the gland has compressive complications

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9
Q

Diagnosis of thyroiditis

A

The diagnosis may be made with aspiration cytology or at surgery. In autoimmune thyroiditis and occasionally in other forms, antibodies may be elevated

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10
Q

Causes of solitary thyroid nodule

A
  • hyperplastic/ adenomatous nodule
  • simple cyst
  • follicular adenoma
  • thyroid carcinoma
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11
Q

Investigation of nodular thyromegaly

A
  • ultrasonography
  • aspiration cytology
  • radio- isotope scanning
  • Ct scan
  • blood tests: thyroid function, tumour markers (calcitonin), serum thyroid antibodies
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12
Q

Features of malignancy of solitary nodule on ultrasound

A

Hypoechogenicity of the nodule, marked increase in vascularity, local lymphadenopathy, microcalcifications

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13
Q

Bethesda classification of reporting thyroid cytopathology

A 
1- non diagnostic 
2- beneign 
3- indeterminate 
4- suspicious for follicular neoplasm 
5- suspicious for malignancy 
6- malignant
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14
Q

Indications for surgery of solitary nodules

A
  • solid nodule as shown on u/s
  • cold area on isotope scanning
  • cytology which is malignant, suspicious or indeterminate
  • cyst which refills after aspiration
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15
Q

Management after a suspicious nodule and containing lobe are removed for histological analysis

A
  • report of beneign disease: no action
  • report indicates malignancy: total thyroidectomy is performed for all types of thyroid cancer except small <1 cm, unifocal papillary ca
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16
Q

Features suggestive of malignancy in thyroid mass

A
  • asymmetrical goiter or solitary nodule in children or men
  • rapid onset
  • progressive increase in size
  • pain
  • local invasion
  • lymphadenopathy
  • hoarseness
17
Q

What are the types of thyroid carcinoma

A
  • well differentiated
  • medullary
  • anaplastic
  • lymphoma
  • other
18
Q

Types of well differentiated carcinomas

A

They can be classified histological to as papillary, follicular or mixed

19
Q

Management of well differentiated thyroid carcinomas

A

Management is surgical complemented by radioactive iodine doses and endocrine therapy (thyroxin). The usual operation is a total thyroidectomy, although a lobectomy may be sufficient in some patients. Lymphadenectomy for patients with lymph node involvement

20
Q

Adverse prognostic indices of thyroid carcinoma

A
  • older patients
  • males
  • undifferentiated lesions
  • spread to lymph nodes
  • distant metastes
21
Q

Where is medullary carcinoma thought to be derived from

A

Calcitonin producing C cells

22
Q

Components of the MEN2 syndrome

A

Phaeochromocytoma
Hyperparathyroidism
neurofibromatosis
Medullary carcinoma

23
Q

Treatment of medullary carcinoma

A

Total thyroidectomy with nodal dissection

24
Q

Causes of thyrotoxicosis

A
  • Graves’ disease
  • toxic multinodular goitre (Plummer’s disease)
  • toxic solitary nodule
  • Excess TSH (pituitary, paraneoplastic)
  • Excess T4 (iatrogenic, paraneoplastic)
  • Excess iodine (Jod basedow)
  • Transient during thyroiditis/ irradiation
25
Q

Normal range for TSH

A

0.37- 3.50

26
Q

Normal range for T4

A

7.2 - 16.4 pmol/L

27
Q

Normal range for T3

A

3.3- 8.1 pmol/L

28
Q

Treatment of thyrotoxicosis

A
  • most patients started in propranolol and neomercazole as remission awaited over 6-18 months
  • if this does not happen, I 131 is given
  • surgery is performed when specially indicate d
29
Q

Indications for surgery in thyrotoxicosis

A
  • pregnancy (during second trimester)
  • hot toxic nodule
  • failed medical treatment
  • iodine contra indicated
  • when there is a large, usually multinodular gland
30
Q

Structural complications of thyroid surgery

A
  • laryngeal nerve damage
  • laryngeal oedema
  • haemorrhage
  • Tracheomalacia
31
Q

Endocrine complications of thyroid surgery

A
  • hypoparathyroidism
  • hypothyroidism
  • thyroid crisis
32
Q

Presentation of recurrent laryngeal nerve paralysis

A
  • unilateral: breathy voice, hoarseness, less commonly dysphagia and aspiration
  • bilateral: presents early with stridor and airway obstruction
33
Q

Cause of serious airway obstruction in early post op following thyroid surgery

A
  • haematoma
  • airway oedema
  • bilateral Recurrent laryngeal nerve damage
  • tracheomalacia
  • later due to hypocalcemia
34
Q

What is tracheomalacia

A

Characterized by flaccidity of the tracheal support cartilage, which in turn leads to tracheal collapse

35
Q

How may hypocalcemia occur as a complication of thyroid surgery

A

This may occur after total thyroidectomy if the parathyroid glands have been inadvertently removed or rendered ischaemic

Gen Surgery (31 decks)

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