ENDOCRINE

Question 1

THYROIDECTOMY

Answer 1

( TOTAL AND LOBE)
CONSENT: .
nerve
parathyroid damage
possibility of completion 
LN Dissection

POSITION:

• . neck hyperextended
• . small pillow at area of upper thoracic spine, beneath shoulder
• . doughnut support under head

INCISION:
2 finger breadths above sternal notch, with crease

platysma flap from sup thyroid cartilage to sternal notch

open deep fascia
elevate strap muscles

sternohyoid easily elevated ( most superficial )

thyrohyoid and sternothyroid carefully separated of thyroid

can be divided (in huge difficult glands

LOBECTOMY:

retract lobe medially and anteriorly

ligate middle thyroid vein

identify RLN by blunt dissection into tracheoesophageal groove

Identify and protect parathyroids

ligate inf thyroid artery

ligate lower pole vessels

ligate upper pole ( en mass ligation, or if possible ligate artery??)

dissect lobe from trachea with knife or cautery

straight Crile clamp is placed between the isthmus and the opposite lobe
• . specimen is sharply excised
• . thyroid tissue within clamp is oversewn with a running interlocking 3-0 silk suture for hemostasis

if indicated → frozen section

CLOSURE:
deep cervical fascia in the midline 3-0 absorbable sutures

platysma reapproximated with interrupted 3-0 absorbable sutures

Question 2

Work up for suspectedThyroid metastasis to the lung

Answer 2

Only need iodine 131 to diagnose

Do not need tissue..

Question 3

Management of thyroid metastasis to the long

Answer 3

Meniscectomy these due okay

Thyroid – okay

They do not do as good as in order:

Colon – best
Sarcoma – pretty good
Reno – pretty good

Rare:
Breast rare indicaiton
Melanoma rare indication

Question 4

Sources of ectopic ACTH

Answer 4

Small cell
Carcinoid!
Adrenal cancer
Adrenal hyperplasia

Question 5

Pertinent history for adrenal incidentaloma

Answer 5

Lung cancer
Ovarian cancer
Melanoma

Question 6

Appearance of pheochromocytoma on CT scan

And MRI

Answer 6

“pressure is up-and-down in pheo and appearances also mixed– Heterogenous”

Heterogenous on CT scan

Mass signal intensity compared to liver signal intensity greater than three for pheochromocytoma on MRI

Question 7

Functional labs needed to evaluate adrenal incedentaloma

Answer 7

24 hour urine:
Plaza metanephrines
Catecholamines
VMA
Cortisol
17 hydroxy keto steroids

Electrolytes:
If a low potassium - hyper aldosteronism

Aldosterone

Hyperglycemia / cortisol access

ACTH

Dexamethasone suppression test
(1 mg dex - cortisol should be less than three – five in the morning)

Question 8

Major strap muscles for thyroidectomy

Answer 8

sternohyoid
(easily elevated - most superficial )

thyrohyoid

sternothyroid carefully separated of thyroid