Endocrine Surgery Flashcards
RECAP- what do thyroid hormones get synthesised from?
Iodine
-> one of the only glands in the body that takes up iodine
What does iodine get coupled to to produce T3/4?
Tyrosine
If someone has a large goitre, what are they likely to be deficient in?
Iodine
List the effects of TH.
Increase is catabolism of carbs/lipids
Increase in protein synthesis
Increase in basal metabolic rate
Growth and maturation
What does the thyroid gland develop from embryologically?
Foramen cecum
Which part of the neck does the thyroid gland lie?
Anterior triangle of neck
What is the blood supply for the thyroid gland?
Superior thyroid artery
Inferior thyroid artery
What is the superior thyroid artery a branch of?
Carotid artery
What is the inferior carotid artery a branch of?
Thyroid cervical trunk
Damage to which nerve causes change in voice, vocal changes or loss?
Recurrent laryngeal nerve
Thyrotoxicosis?
Clinical syndrome of excess circulating TH, commonly sue to hyperthyroidism
What are some of the primary causes of hypothyroidism?
Autoimmune thyroiditis
Dietary insufficiency
Surgery
Radioiodine
What are some of the secondary causes of hypothyroidism?
Pituitary failure
Goitre?
Enlargement of thyroid gland
What is Pemberton’s sign used to evaluate?
Venous obstruction in patients with goitres
How can goitres affect airways?
Can cause compression of the airway
->classical sign of airway compression is stridor
What are the most common complications of a thyrodidectomy?
Damage to recurrent laryngeal nerve
Damaging parathyroid glands, in turn causing low calcium levels
Bleeding
Wound problems
Requiring long term thyroid supplements
What are the four types of thyroid cancer?
Papillary
Follicular
Medullary
Anaplastic
Where does medullary thyroid cancer arise from?
Calcitonin releasing C-cells
Thyroid cancer has a good prognosis except for which type?
Anaplastic- very poor prognosis
Where can thyroid cancer spread to?
Bone, lymph nodes and lungs
How do we get a tissue diagnosis to determine the type of thyroid cancer?
Fine needle aspiration cytology (FNAC)
What are some of the treatment options for thyroid cancer?
Surgery
Radioiodine
What are the parathyroid glands developed from embrylogically?
Pharyngeal pouches
What does the parathyroid hormone do?
Control homeostasis of calcium in the bloodstream, along with vitamin D
RECAP- what are the classic symptoms of hypercalcaemia?
Stones, bones, moans and psychic groans
-kidney stones, bone pain, abdominal pain and constipation
RECAP- if calcium levels are low, what should the PTH levels be like?
High
What is a sesatmibi scan?
Sestamibi is a radio labelled isotope which is taken up by metabolically active tissue.
Helps to work out which parathyroid gland is the issue in parathyroid surgery
What supplies blood to the adrenal glands?
Branches of the renal artery
In post-menopausal women, where does the main source of testosterone and oestrogen come from?
Adrenal gland
RECAP- what does excess cortisol cause?
Cushing’s syndrome
RECAP- symptoms of Cushing’s.
Signs of Cushing’s.
Symptoms- weight gain, central obesity, moon face, easy bruising, thin skin, purple abdominal striae, infertility
Signs- hypertension, diabetes, impaired glucose tolerance, osteoporosis
What is produced in excess in Conn’s syndrome?
Mineralocorticoids
Random but
This lecture is a pretty good overview of everything learned so far if want one lecture for overview xx
What does the adrenal medulla produce when stimulated by the sympathetic NS?
Adrenaline and noradrenaline
Why are pheochromocytoma’s referred to as the 10% tumour?
10% of them arise outwith the adrenal gland
10% familial
10% malignant
10% multiple
When diagnosing pheochromocytoma’s, what is measured?
Metabolites known as metanephrines in the urine
->not adrenaline measured as levels fluctuate so quickly in the bloodstream
What do neuroendocrine tumours secrete?
Serotonin and chromogranin
MEN (multiple endocrine neoplasia)?
A group of familial symptom syndromes where patients have multiple endocrine tumours of the pituitary, parathyroid, thyroid, adrenal and the pancreas
What is MEN1?
Tumours of the parathyroid glands which are often accompanied with tumours of the anterior pituitary and endocrine pancreas
What is MEN2?
Medullary thyroid cancer often accompanied with pheochromocytoma and parathyroid tumour
