Endocrine Surgery Flashcards
What are some post operative complications following thyroid surgery?
Neck bleeding
- usually immediately or on ward
- compression of haematoma into the neck
Acute bilateral Recurrent Laryngeal nerve injury
Acute thyrotoxic crisis
- due to handling of the gland
Hypocalcemia
- removal of the parathyroid glands
What are the benign causes of an enlarged thyroid?
Non- toxic goitre/ hyperplasia of the thyroid
Thyroid adenoma
Thyroid cyst - colloid cyst
thyroglossal cyst (although this doesn’t usually sit on the thyroid)
What are the common causes for a non-toxic goitre?
Iodine deficiency
- most common cause
physiological demand for thyroid hormones
- pregnancy
- teenagers
Goitrogens
- substances which promote hormone synthesis
What are the symptoms of a goitre and what investigations are done into goitres?
Usually asymptomatic:
Dyspnea
Dysphagia
Hoarseness of voice
Investigations:
- TFTs
- Ultrasound +/- FNA
- CXR - looking for tracheal deviation
- Radionuclide uptake (malignant tend to be cold)
*if the TFTs were off - then FNA should be carried out to define what it is.
What is the treatment of a non- toxic goitre?
medical:
- levothyroxine - replace deficiency
- Radioactive iodine
Surgical
- thyroid lobectomy
- thyroidectomy
What are the symptoms of a thyroglossal cyst?
Painless midline cyst
if infected:
- pain
- fistula formation
*inflammation often occurs following URTI
What are the investigations into thyroglossal cyst and what is the management?
Ultrasound
FNA - straw colour will come out
Treatment:
Antibiotics - if infected
Drainage - if infected
Elective surgery
What are the types of malignant tumours one can get in their thyroid, and how what is their prevalence?
Papillary carcinoma:
- most common malignant
- females/ young children
- good prognosis
- spreads to lymph nodes first
Follicular Carcinoma:
- elderly females
- solitary nodule
- spreads late
Medullary:
- Associated with MEN -IIa and IIb
- excessive calcitonin release - C cell release
- must carry out CT of abdomen for risk of pheochromocytoma
Anaplastic
- older women
- rare and extremely aggressive
Thyroid lymphoma
- B cell - non hodgkin lymphomas
- rarely associated with long standing hashimotos disease
What are the types of benign tumours of the thyroid?
Colloid Adenoma / Cyst
- most common
Follicular adenoma
- develops in a pseudocapsule
What diagnostic investigations should be carried out on thyroid tumours?
TFTs Thyroid antibodies FNA - ultrasound guided Neck ultrasound ECG
What is the grading system used for thyroid cancers?
following from FNA, they are given a point score:
- thy 1 = non diagnostic
- thy 2 = benign colloid
- thy 3 = follicular or colloidal - further investigation
- thy 4 = suspicion of malignancy
- thy 5 = diagnostic of thyroid cancer
Which type of thyroid cancer can have a neoplastic effect? and what is it?
Medullary:
- cushing’s effect
What are some emergencies following thyroid surgery?
Neck bleeding:
- pressure hematoma on neck
- dyspnea
- pain
- stridor
- cyanosis
- give high flow O2.
- cut Stitches on ward if needs be
- CPR if needed
- fluid resuscitation
Acute bilateral Recurrent laryngeal injury:
- paralysis of both vocal cords causing acute airway obstruction
- noticed when extubation is carried out
- stridor
- O2 stats fall
- re-intubation
- emergency cricothyroidotomy
Acute Thyrotoxic Crisis: caused by handling of thyroid - sweating - fever - tachycardia - AF
- fluid resuscitation
- High flow O2
- may need transferred to ICU to manage effects
Hypoglycaemia
- due to removal of parathyroid glands
*Supplementation of Ca2+ and Vit D
What are the most common causes of hyperparathyroidism?
Parathyroid Adenoma
- most common in postmenopausal women
Hyperplasia of parathyroid glands
- MEN I
Parathyroid cancer
- this is rare
What investigations should be done into hypercalcaemia?
Adjusted Ca2+ levels
PTH levels
Urine Ca2+ levels
Bone scan
Drug history:
- lithium
- vitamin D
Check for malignancy
- this is the 2nd biggest cause
If a patient present with hypercalacaemia and high PTH, what investigations should be done?
High resolution US sound of neck
Sestamibi scan - radioisotope scanning
What is the treatment for adenoma of the parathyroid? and what are the indications for surgery?
minimally invasive parathyroidectomy
- symptomatic
- Ca2+ >3
- <50 years
- End organ damage
What are the symptoms of parathyroid cancer?
Severe hypercalcemia
excessive high PTH
local infiltration
*80% survival rate
What are the most common causes of pancreatic cancer?
Adenocarcinoma
- usually effects the head of the pancreas
Ampullary tumour
Pancreatic islet tumour
