ENDOCRINE Flashcards
Painful thyroid + thyrotoxicosis
subacute granulomatous thyroiditis
Phases of subacute granulomatous thyroiditis
Initial hyperthyroid (similar to influenza) and low uptake on RAI uptake scans.
RAI uptake with Graves disease
Increased
RAI uptake with postpartum thyroiditis
Hyperthyroid phase
Decreased RAI uptake
Riedel thyroiditis
Rare chronic inflamm disease of thyroid that causes fibrosis of thyroid –> hard, nontender thyroid
Antibodies assoc with Graves disase
Thyroid stimulating hormone receptor antibodies
1.8 cm thyroid nodule –> FNA shows follicular lesion. Next stop?
Diagnostic lobectomy and/or molecular testing
Central neck LN
Level VI
Lateral neck LN
Level II-V
Primary hyperPTH + medullary thyroid CA should raise suspicion for?
MEN 2A - look for pheo!
For pts with highest risk mutation RET proto-oncogene (Men IIB) when should thyroidectomy be performed?
Before age 1 or at time of dx. Also check calcitonin, US and r/o pheo.
Bacteria in suppurative thyroiditis
Staph aureus or strep pyo
Calcitonin levels after thyroidectomy in MEN 2A
Slowly decrease and may not reach nadir for several months
Follicular neoplasm on FNA
Thyroid lobectomy
Rapidly growing thyroid mass with FNA showing large irregular lymphoid cells
Thyroid lymphoma - give chemoXRT (CHOP).
Bethesda III - next step?
Repeat FNA or lobectomy atypica of undetermined significance or FLUS
Signs that lymph node is mets
Malignant LN may demonstrate increased size, round shape, loss of central fatty hilum/thinning of hilum, peripheral or mixed vascualrity, presence of microcalcifications, or ill-defined margins
Tumor marker for PTC
Thyroglobulin
Preoperative SSKI/Lugol iodine before thyroidectomy reduces?
Intraoperative blood loss (decreases vascularity of thyroid gland)
Level III LN location
Middle internal jug chain
Inferior margin of hyoid to inferior margin of cricoid, anterior to posterior border of SCM, lateral to medial margin of common carotid a
Which medications can increase hepatic metabolism of thyroid hormone?
Antiepileptics (including phenobarb, carbamazepine and phenytoin). Pts on these meds often require higher than normal doses of thyroxine
In Men 2a, what surgery comes first?
Adrenalectomy
What size nodules do not require routine sonographic follow up
If purely cystic/low suspicion on US and <1 cm
ANtibodies assoc with Hashimoto thyroiditis
Antithyroid peroxidase antibodies