Emma Holliday for Surgery: Part VII Flashcards
First step in working up a thyroid nodule
Check TSH
You check the TSH for a thyroid nodule, what next?
If low, do a RAIU scan to find the “hot nodule.” Excise it or kill it with radioactive iodide.
If normal, get an FNA
FNA of your nodule is done. What next?
If benign, leave it alone.
If malignant, excise it and check pathology
If indeterminant, re-bx it or check a RAIU scan
If the nodule comes back cold, what next?
Excise it, check pathology
5 types of cold nodular pathologies
Papillary Follicular Medullary Anaplastic Thyroid lymphoma
Pathology of papillary cold thyroid nodule
MC type, spreads via lymph, psammoma bodies
What pre-disposes someone to a thyroid lymphoma
Predisposed by hashimotos
Pathology of follicular cold thyroid nodule
Spreads via the blood.
Better excise the whole thing
Pathology of Medullary cold thyroid nodule
Associated with MENII. Look for pheochromocytoma and hypercalcemia. You wil lsee amyloid and calcifications in pathology
Pathology of Anaplastic cold thyroid nodule
80% mortality in first year. No bueno.
4 functional versions on an adrenal nodule
Pheochromocytoma
Primary aldosteronism
Adrenocortical carcinoma
Cushing or silent cushing syndrome
Features of Pheochromocytoma and how we test for it
HTN, catechol symptoms
Get urine and plasma-free metanephrines
Features of primary aldosteronism and how we test for it
HTN, low K+ and low PRA
Plasma aldosterone-to-renin ratio
Features and testing for adrenocortical carcinoma
Virilization or feminization
Get a Urine 17-ketosteroid
Features and testing for cushings
Cushing symptoms or normal exam results otherwise
Test with an overnight 1-mg dexamethasone test
If the adrenal nodule is less than 5cm and non functional, what do you do
Observe with CT scans every 6 months
What if the adrenal nodule is greater than 6 cm or functional
Surgical excision.
Causes of hypothyroidism and what we see in the patient and labs
Typically from thyroidectomy
We see perioral numbness, chvostek’s and Trousseaus due to low calcium
Labs: Low calcium, high phosphate and low PTH
Presentation of hyperparathyroidism
Usually asymptomatic increase in calcium but can present with kidney stones, abdominal or psychiatric symptoms
Labs for hyperparathyroidism
High calcium, low phosphate, high Vitamin D and high parathyroid hormone
Diagnosing hyperparathyroidism
FNA of suspicious nodules. Can use Sestamibi scan
Treating hyperparathyroidism:
Surgical removal of adenoma. If hyperplasia, remove all 4 glands and implant 1 in the forearm
MEN 1
Pituitary adenoma, parathyroid hyperplasia, pancreatic islet cell tumor
MEN 2a
Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma