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Diagnostic Imaging > ENDOC- THYROID > Flashcards

ENDOC- THYROID Flashcards

1
Q

Describe the anatomy of the thyroid.

A
  • Paired lobes of near-equal size (5 × 2 × 2 cm)
  • connected by isthmus
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2
Q

Describe the parenchyma of thyroid.

A

Parenchyma: Homogeneous with fine medium-level echogenicity greater than that of the muscle.

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3
Q

The thyroid’s anatomic landmarks are:

Midline

A

Anatomic landmarks:

  • : air-filled trachea which casts an air shadow
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4
Q

The thyroid’s anatomic landmarks are:

Lateral edge:______________

A

common carotid artery and internal jugular vein

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5
Q

The thyroid’s anatomic landmarks are:

Posteriorly:________________

A

longus colli muscles

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6
Q

The thyroid’s anatomic landmarks are:

Anteriorly:

A
  • sternohyoid,
  • sternothyroid,
  • and sternocleidomastoid muscles
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7
Q

connected across the trachea by a thin thyroid______________

A

isthmus

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8
Q

The thyroid lobes are often _______________ in size.

A

mildly asymmetric

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9
Q

The ______________-** commonly protrudes** from behind the trachea, nearly always on the left side, and must not be mistaken for a thyroid or parathyroid mass or lymph node (Fig.

A

esophagus

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10
Q
A
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11
Q

In the UTZ of the Thyroid, what probe is used and why?

A

We use the LINEAR PROBE

Because Linear probe is used only for superficial organs and Thyroid is an example.

NOTE: The CURVE probe is used for deep seated organs.

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12
Q

What is the ◦First choice and the most sensitive imaging modality for thyroid?

A

§Ultrasound

Note : can give anatomical but not FUNCTIONAL

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13
Q

◦ provides excellent functional information about the thyroid gland
“Hot” or “Cold

A

Thyroid scintigraphy

Note: Can give FUNCTIONAL but less of ANATOMICAL incontrast with UTZ

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14
Q

In thyroid scintigraphy:

HOT :

A

DARKER

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15
Q

In thyroid scintigraphy,

COLD:

A

lighter

Nmemonics: Hot place: DARKER people

Cold place: Lighter People

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16
Q
A

Thyroid Hot and Cold Scintigraphy

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17
Q

Extremely common:
◦4% to 8% of adults have palpable nodules
◦10% to 41% have nodules on US examination
◦50% have nodules at autopsy.
Increase in frequency with age
** More common in women. **

A

Thyroid Nodules

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18
Q

How many percent of the adult have thyroid nodules?

A

4% to 8%

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19
Q

What gender is more common for Thyroid nodules?

A

Female

” Tandaan kasi baka dahil sa when going through pregnancy dba increase thyroid hormones.. baka lng.. link link hehe”

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20
Q

What are the parameters of Malignant Thyroid nodules?

A
  1. Iso- or HYPERechoic
  2. MACROcalcifications
  3. Regular border
  4. No infiltrative margins
  5. absent of abnormal cervical lymph nodes
  6. Periphery nodular vascularity
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21
Q

What are the parameters of malignant Thyroid nodules in UTZ?

A
  1. Hypoechoic
  2. Microcalcifications
  3. Border irregularity
  4. infiltrative margins
  5. abnormal cervical lymph nodes
  6. Increased intranodular vascularity
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22
Q

What are your BENIGN THYROID NODULES?

A

ØAdenomatous nodules
ØFollicular adenoma
ØThyroid cyst
ØHemorrhage

NMEMONICS: FATH

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23
Q

Thyroid cancer, on the other hand, affects only ____________ of the population.

Thyroid cancer is less than 1% of all cancer and is the cause of less than 0.5% of all cancer deaths.

Most thyroid cancers are slow growing and have low morbidity and mortality.

A

0.1%

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24
Q

The ratio of benign thyroid nodules to thyroid cancer can be estimated at as high as ____________-.

The challenge of imaging studies and clinical evaluation is to establish the likelihood of malignancy and to select out for surgery only those patients with thyroid malignancy.

A

500:1

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25
Q

select out for surgery only those patients with_________________

A

** thyroid malignancy.**

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26
Q
    • Colloid nodules**
    • Most common thyroid nodule.**
A

Adenomatous Nodules

27
Q

Adenomatous Nodules result from the_____________

A

Growths resulting from cycles of hyperplasia and involution of thyroid tissue
Multiple and associated with diffuse enlargement of the thyroid gland.

28
Q

What are the imaging finding of Adenomatous Nodules?

A

Imaging findings:
◦Isoechoic or hypoechoic to thyroid parenchyma
◦May show degenerative changes with prominent cystic components, necrosis, hemorrhage, and calcification

29
Q
A

dominant nodule (between arrowheads) with cystic change (arrow) measuring 18 mm in greatest dimension.

This nodule meets the Society of Radiologists in Ultrasound criteria for fine-needle aspiration (FNA).

US-guided FNA biopsy yielded a cytologic diagnosis of “colloid nodule” indicating visualization of benign thyroid cells and thyroid colloid.

Note the homogeneous pattern of the visualized normal thyroid parenchyma (Thy).

30
Q

Most common benign neoplasm
Autonomous hyperfunctioning adenomas
◦Hyperthyroidism

A

Follicular Adenoma

31
Q

What are the imaging finding of Follicular Adenoma?

A

Imaging findings:
◦Most are solitary, solid, and well encapsulated.
◦Hypoechoic, hyperechoic, or isoechoic to thyroid parenchyma
◦Hyperfunctioning adenomas = strikingly hypervascular on Doppler US.
◦Degenerative changes

32
Q

Hyperfunctioning adenoma appears ___________ on Doppler UTZ

A

◦Hyperfunctioning adenomas = strikingly hypervascular on Doppler US.

33
Q

cause no alteration of overall thyroid function.

include focal necrosis, hemorrhage, edema, infarction, fibrosis, and calcification.

Differentiation from follicular carcinoma is difficult; therefore an ___________________________ is commonly considered an indication for surgical removal and histologic determination of the presence of cancer.

A

FNA cytologic diagnosis of follicular neoplasm

34
Q
A

Follicular Adenoma

Dominant thyroid nodule (between cursors, x, +) with an irregular area of cystic change is evident (arrow).

Because a diagnosis of follicular carcinoma could not be excluded, this lesion was surgically removed.

No histologic evidence

Differentiation from follicular carcinoma is difficult; therefore an FNA cytologic diagnosis of follicular neoplasm is commonly considered an indication for surgical removal and histologic determination of the presence of cancer.

35
Q
A

Follicular Adenoma

Showing hypervascularity

36
Q
  • Extremely rare,
  • epithelial-lined,
  • simple cysts.
  • Cystic degeneration of an adenomatous nodule (“colloid cyst”) or a follicular adenoma.
A

Thyroid Cyst

37
Q

Colloid Cyst

A

_______________Comet Tail Artifact.

A sharply defined cystic lesion within the right thyroid lobe shows floating punctate echogenic foci with a tapering tail (arrow).

This comet tail artifact is characteristic of inspissated colloid and a benign lesion.

38
Q
A

Colloid Cyst—Comet Tail Artifact. A sharply defined cystic lesion within the right thyroid lobe shows floating punctate echogenic foci with a tapering tail (arrow).

This comet tail artifact is characteristic of inspissated colloid and a benign lesion.

39
Q

This comet tail artifact is characteristic of _______________

A

inspissated colloid and a benign lesion.

40
Q

May occur into an adenomatous nodule or a follicular adenoma, or spontaneously into normal parenchyma.
Patients present with sudden neck pain and subsequent swelling.

A

Hemorrhage

41
Q

Imaging Findings Of Hemorrhage in
Ultrasound:

A

** hypo**echoic nodule with internal debris.

42
Q
A

Ultrasound: hypoechoic nodule with internal debris.

43
Q

Malignant Thyroid Nodules

A

§Papillary thyroid carcinoma
§Follicular thyroid carcinoma
§Medullary thyroid carcinoma
§Anaplastic thyroid carcinoma
§Others:
§Lymphoma
§Metastasis

44
Q

Among the malignant thyroid nodules this is the most common and comprises 75- 80 %

A

§Papillary thyroid carcinoma

45
Q

Follicular thyroid ca is %

A

10-20%

46
Q

3-5 % of the malignant thyroid nodules is

A

Medullary thyroid ca

47
Q

1-2% of malignant Thyroid nodules is

A

§Anaplastic thyroid carcinoma

48
Q

least aggressive cancers in human.
Female (4:1)

A

Papillary Thyroid Carcinoma

49
Q

What is the imaging finding in Papillary Thyroid Ca

A

Imaging Findings:

  • ◦Nodules are hypoechoic and commonly multiple.
  • ◦Punctate internal calcifications (Psammoma bodies,42%)
  • ◦Characteristic parenhymal microcalcifications without a discrete mass present.
  • **◦Cervical nodes may contain similar calcifications. **
50
Q

in papillary thyroid CA___________,42%) and highly indicative of malignancy

A

Psammoma bodies

51
Q

The Papillary thyroid CA tumor spreads commonly to regional nodes, but rarely ____________ spreads to lung or bone. Five-year survival is 95% to 99%.

A

(2% to 3%)

52
Q
A

Papillary Thyroid Carcinoma

Papillary Carcinoma of the Thyroid—Microcalcifications. Longitudinal image reveals a solid nodule containing numerous punctate nonshadowing echogenic foci characteristic of microcalcifications associated with papillary carcinoma indicative of malignancy. Biopsy proved papillary carcinoma.

53
Q

** characteristic of microcalcifications** associated with papillary carcinoma indicative of malignancy. Biopsy proved papillary carcinoma.

A

** solid nodule** containing numerous punctate nonshadowing echogenic foci

54
Q

** Slow-growing malignancy**
** Blood vessels invasion = Characteristic!**
Hematogenous spread to lung and bone.
** Male gender** and older age

A

Follicular Thyroid Carcinoma

55
Q

What is the imaging finding of Follicular Thyroid CA?

A

◦Solitary, isoechoic, and ill defined.
◦Cystic areas, hemorrhage, and necrosis
Larger size, lack of an echolucent halo, hypoechoic appearance, and absence of cystic change

56
Q

In Follicular Thyroid CA Clinical features that favor malignancy are ____________. Five-year survival is about 65%.cal nodes is uncommon.

A

male gender and older age

57
Q

The sonographic features of follicular carcinoma

Features that favor carcinoma over adenoma include

A

larger size, lack of an echolucent halo, hypoechoic appearance, and absence of cystic change

58
Q

Microlcalcification of > or =1 cm

A

Strongly consider US- guided FNA

59
Q

Solid) almost entirely or with central calcification)

> or = 1.5 cm

A

Stongly consider US-guided FNA

60
Q

Mixed solid and cystic or almost entirely cystic with a solid mural component

> or = 2 cm

A

Consider US- guided FNA

61
Q

Substantial growth since prior US

A

ConsiderUS-guided FNA

62
Q

Almost entirely cystic with none of the above and no substantial growth ( or no prior US)

A

US-guided FNA probably not necessary

63
Q

Multiple nodules

A

Consider US-guided FNA of one or more of the nodule selected by criteria listed for solitary nodules

64
Q
A

Diagnostic Imaging (6 decks)

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