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Surgery > Endocrine surgery- thyroid and parathyroid > Flashcards

Endocrine surgery- thyroid and parathyroid Flashcards

1
Q

What hormones are secreted by thyrocytes?

A

T3- active form

T4 (thyroxine)- peripherally converted to T3

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2
Q

Hormone released by the parafollicular cells and its action?

A

Calcitonin- lowers serum calcium (but not an essential hormone)

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3
Q

Investigations required for thyroid disease? (2)

A

Thyroid function tests (mainly TSH)

Ultrasound/FNA cytology

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4
Q

Which conditions reduce the amount of free thyroid hormone? (2)

A

Pregnancy, exogenous oestrogen

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5
Q

How does toxic multinodular goitre develop?

A

Long-standing non-toxic goitre develops hyperactive nodules which function independently of TSH

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6
Q

Solitary thyroid nodules can be…(3)

A

Cyst
Adenoma
Cancer

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7
Q

Rare condition where thyroid is replaced by dense fibrous tissue?

A

Riedel’s thyroiditis

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8
Q

Self-limiting condition associated with viral infection, which presents with thyroid pain and may cause hypo/hyper/euthyroidism?

A

Sub-acute thyroiditis (de Quervain’s disease)

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9
Q

Autoimmune condition causing destruction of follicles and hypothyroidism?

A

Hashimoto’s disease (autoimmune thyroiditis)

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10
Q

Three main conditions which present with thyrotoxicosis?

A

Grave’s disease (primary thyrotoxicosis)
Toxic multinodular goitre
Toxic adenoma

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11
Q

Management options for Grave’s disease?

A

Carbimazole (blocks incorporation of iodine into tyrosine)
Radio-iodine
Thyroidectomy

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12
Q

What needs to happen before surgery for thyrotoxicosis can take place? Why?

A

Patient must be rendered euthyroid by anti-thyroid drugs (e.g. carbimazole)

To prevent peri-operative thyroid storm

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13
Q

How do toxic multinodular goitre/toxic adenoma present distinctly from Grave’s disease?

A

Eye signs (e.g. exopthalmos, opthalmoplegia) are rare

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14
Q

Management of toxic multinodular goitre/toxic adenoma?

A

Thyroidectomy/thyroid lobectomy

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15
Q

Four types of thyroid cancer in order of prevalence?

A

Epthelial: Papillary (50%) and Follicular (30%)
Anaplastic
Medullary

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16
Q

Main risk factors for thyroid cancer to inquire about?

A

Family history

History of radiation exposure

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17
Q

Main differences between papillary and follicular thryoid cancers?

A

Papillary spreads to local lymph nodes but rarely disseminates widely; 10yr survival is around 90%

Follicular spreads haematogenously usually to bone; 10yr survival around 75%

18
Q

Treatment of epithelial thyroid cancers?

A

Total or near-total thyroidectomy; thyroid replacement to suppress TSH

19
Q

Clinical features of anaplastic thyroid cancer? (3)

A

Rapid growth and highly malignant
Local invasion and pulmonary metastases are common
Curative resection rarely possible, most patients die within a year

20
Q

Lymphoma of the thyroid is a rare complication of…?

A

Autoimmune thyroiditis

21
Q

Tumour arising from the parafollicular C cells?

A

Medullary carcinoma

22
Q

Medullary carcinoma often arises as part of what syndrome?

A

Multiple endocrine neoplasia Type II

23
Q

Important considerations in thyroid surgery?

A

Protection of the recurrent laryngeal nerve
Meticulous haemostasis
Protection of the parathyroid glands

24
Q

Possible consequences of secondary haemorrhage in neck surgery?

A

Compression of structures in the thoracic inlet causing laryngeal oedema, tracheal compression, asphyxia

25
Q

Post-operative complications of thyroid surgery? (4)

A

Recurrent laryngeal nerve damage
Hypoparathyroidism
Hypothyroidism
Hypertrophic/keloid scar

26
Q

Causes of hypercalcaemia? (4)

A

Hyperparathyroidism
Increased calcium absorption
Excessive bone breakdown
Ectopic secretion of PTH-like hormone

27
Q

How does PTH bring about a rise in serum calcium? (3)

A

Increases the activity of osteoclasts
Increases renal synthesis of vitamin D (which increases gut absorption of calcium)
Increases renal reabsorption of calcium

28
Q

Primary hyperparathyroidism is usually due to…?

A 
Adenoma of the parathyroid gland (90%)
Diffuse hyperplasia (10%)
29
Q

Clinical features of hyperparathyroidism?

A 
Polyuria leading to dehydration
Kidney stones
Peptic ulcer (and abdominal pain)
Pancreatitis
Psychosis
30
Q

Investigations in suspected hyperparathyroidism?

A

Hypercalcaemia in the presence of circulating PTH
Low serum phosphate
Increased urinary calcium excretion

31
Q

Over-secretion of PTH in response to low levels of ionized calcium?

A

Secondary hyperparathyroidism

32
Q

What typically causes secondary hyperparathyroidism?

A

Renal disease or calcium malabsorption from the gut

33
Q

What is tertiary hyperparathyroidism?

A

Autonomous secretion of PTH from gland in secondary hyperparathyroidism

34
Q

Management of primary hyperparathyroidism?

A

Removal of adenoma; if hyperplasia, subtotal parathyroidectomy

35
Q

What may occur temporarily after parathyroidectomy?

A

Hypoparathyroidism (causing hypocalcaemia)

36
Q

Symptoms of hypocalcaemia? (3)

A

Paraesthesia in hands and feet
Muscle cramps and tetany
Lethargy and depression

37
Q

Clinical signs of hypocalcaemia? (3)

A

Chvostek’s (twitching of the facial muscles on facial nerve tapping)
Trousseau’s (spasm of hand muscles after applying a tourniquet)
Erb’s sign (hyperexcitability of muscles on electrical stimulation)

38
Q

ECG abnormality in hypocalcaemia?

A

Lengthened QT interval

39
Q

Possible life-threatening complication of acute hypoparathyroidism?

A

Respiratory obstruction with stridor due to spasm of laryngeal muscles

40
Q

Important aspects of patient consent for parathyroidectomy? (2)

A

Patient should be informed of:
variable position of the gland and therefore difficulty in finding it
potential need for calcium/Vitamin D supplementation after surgery

41
Q

Medullary thyroid cancers often secrete which hormone?

A

Calcitonin

42
Q

Psammoma calcification is diagnostic of…

A

Papillary thyroid cancer

Surgery (21 decks)

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