Endocrine University 2014 Flashcards by Black RoSe

How big does a thyroid nodule need to be to be detected by thyroid ultrasonography?

2 - 3 mm

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How much does the thyroid gland weigh?

20 - 25 grams

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Describe echogenicity of normal thyroid gland on thyroid ultrasonography.

High intensity homogeneous echo pattern with little identifiable internal architecture.

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Describe echogenicity of Hashimoto’s thyroiditis on thyroid ultrasonography.

Heterogeneous hypoechoic echotexture.

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How thick is a normal thyroid isthmus?

Less than 5 mm

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How do you measure the volume of the thyroid gland on ultrasonography?

Calculate volume by multiplying the three dimensions (W x D x L) and then multiplying by a correction factor (formula of an ellipsoid).
Traditional correction factor: pi/6 = 0.524
WHO recommendation: 0.479
Acceptable correction factors: 0.494 - 0.554.

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What is a nodule with a hilar line on thyroid ultrasonography?

Lymph node

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What happens to the lymph nodes in Hashimoto’s thyroiditis?

Matted clustered nodes, often with abnormal shape and loss of hilar line.

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Frequency of which cancer is increased in Hashimoto’s thyroiditis?

Papillary thyroid cancer.

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What should you do when you feel a thyroid nodule?

Get a thyroid ultrasound.

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Thyroid Ultrasonography

Are benign nodules more likely to be hyper- or hypoechoic?

Hyperechoic

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Thyroid Ultrasonography

Smooth margin often with a ‘halo’.

More likely to be:
Benign or malignant?

Benign

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Thyroid Ultrasonography

Thick, irregular halo.

More likely to be:
Benign or malignant?

More suggestive of malignancy.

Follicular or Hurthle cell carcinoma or adenoma.
Encapsulated papillary cancer follicular variant.

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Thyroid Ultrasonography

Thin-walled cyst without a solid component.

More likely to be:
Benign or malignant?

Benign.

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Thyroid Ultrasonography

Colloid within cystic nodule - comet tail or ‘cat’s eye’.

More likely to be:
Benign or malignant?

Benign

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Thyroid Ultrasonography

Intact eggshell calcification.

More likely to be:
Benign or malignant?

Benign

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Thyroid Ultrasonography

Interrupted eggshell calcifications.

More likely to be:
Benign or malignant?

More likely malignant.

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Thyroid Ultrasonography

Low vascularity.

More likely to be:
Benign or malignant?

Benign.

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Thyroid Ultrasonography

Multiple blocks of hyperechogenicity separated by bands of hypoechogenicity.

More likely to be:
Benign or malignant?

Benign

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Thyroid Ultrasonography

Do discrete nodules need to be evaluated individually?

Yes

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Thyroid Ultrasonography

Spongiform echotexture.

More likely to be:
Benign or malignant?

Benign

Only 1 in 360 cancers have this appearance.
Specificity: 99.7%

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Thyroid Ultrasonography

Name the nodules with the following descriptions:

aggregation of multiple microcystic components in more than 50% of the volume of the nodule.
“honeycomb of internal cystic spaces”

“Spongiform” nodules

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What is the best indication of a benign thyroid nodule on thyroid ultrasonography?

Shrinkage of a nodule over time.

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Thyroid Ultrasonography

Hypoechoic solid nodule.

More likely to be:
Benign or malignant?

Malignant

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Thyroid Ultrasonography What are the following characteristics suggestive of? - Hypoechoic or heterogeneous nodule. - Irregular or 'infilterative' margins. - Irregular mural component of cyst. - Invasion of adjacent tissue/muscle. - Sonographically suspicious cervical lymphadenopathy. - Microcalcifications/macrocalcifications - 'Taller than wide' shape on transverse view.

Papillary thyroid cancer

Thyroid Ultrasonography 'Intra-cystic cauliflower appearance' What is the likely diagnosis?

Cystic papillary carcinoma

Thyroid Ultrasonography How big are macrocalcifications and what do they look like?

More than 2 mm. | Dense hyperechoic spots with acoustic shadowing.

What is the term 'thyroid inferno' used to describe?

Increased vascularity seen on Doppler US in Grave's Disease.

Is there one definition of 'adequate sample' when preparing thyroid slides?

Adequate thyroid FNA biopsy according to The Papanicolaou Society of Pathology ...

6 - 8 groups of well preserved follicular cells with 10 or more cells per group. "6 groups of 10"

How many surgical levels in the neck are they?

6 Labeled in Roman numerals.

Surgical compartments of the neck: Compartment I

Submandibular to the hyoid bone in the center (under the chin).

Surgical compartments of the neck: Compartment VI

From the submandibular notch to the hyoid bone - in the center of the neck.

Surgical compartments of the neck: Compartment V

Posterior to the sternocleidomastoid.

Surgical compartments of the neck: Compartment IV

From the clavicle to the cricoid cartilage deep to the sternocleidomastoid on the lateral sides of the neck.

Surgical compartments of the neck: Compartment III

Between the cricoid cartilage and the hyoid bone deep to the sternocleidomastoid on the lateral sides of the neck.

Surgical compartments of the neck: Compartment II

From the hyoid bone to the base of the skull and angle of the mandible. IIB - deep to the sternocleidomastoid. IIA - anterior to the sternocleidomastoid.

Does prophylactic lateral neck dissection improve recurrence free survival in patients with preoperative US negative for lymph nodes?

Does lateral neck dissection alter the outcome in patients with preoperative US positive for lymph nodes?

Modified neck dissection at the time of initial thyroidectomy improves survival if there is 'macroscopic' lateral lymph node metastasis on ultrasonography.

What should be done when an abnormal/suspicious lymph node is detected on thyroid ultrasonography?

If a positive result would change management then the lymph node should be biopsied for cytology with thyroglobulin measurement in the needle wash out fluid.

How big does an abnormal lymph node found on thyroid US have to be before it can be biopsied?

Greater than 5 - 8 mm in its smallest diameter.

What gauge needle should you use for thyroid FNA biopsy?

25 - 27 gauge

What gauge needle should you use for draining thyroid cysts?

22 gauge

If there is blood in the hub is the dwell time too long or too short?

Too long.

Which receptor is cabergoline specific for?

Which drug has been shown to be more likely to cause valvular abnormalities - bromocriptine or cabergoline?

Cabergoline

When was I-131 discovered?

1938

Who discovered I-131?

Glen Seaborg

What is the half life of I-131?

8 days

Do Doppler grades apply to parathyroid glands?

Is the brand name of the machine and the mHz of the probe relevant to the thyroid ultrasound report?

Which two words do you use to describe the texture of the thyroid gland on ultrasonography?

Heterogeneous | Homogeneous

Does growth hormone deficiency persist into adulthood?

It does usually persist.

What is the AACE recommended HbA1c goal for patients without concurrent illness and at low risk for hypoglycemia?

6.5% or less.

Name two alpha glucosidase inhibitors.

Acarbose. | Miglitol.

What is the mechanism of action of alpha-glucosidase inhibitors?

Delays/decreases carbohydrate absorption from the intestine.

Name one amylin analogue.

Pramlintide.

What is the mechanism of action of amylin analogues? | 3 points

- Decreases glucagon secretion. - Slows gastric emptying. - Increases satiety.

What is the mechanism of action of biguanides? | 2 points

- Decreases HGP | - Increases glucose uptake in muscle.

Name one bile acid sequestrant.

Colesevelam

Name four DPP-4 inhibitors.

Saxagliptin Sitagliptin Linagliptin Alogliptin

What is the mechanism of action of DPP-4 inhibitors? | 2 points

- Increase glucose-dependent insulin secretion. | - Decreases glucagon secretion.

Brand Name: Nesina Generic: ?

Alogliptin

Brand name: Tradjenta | Generic: ?

Linaglipin

Brand Name: Onglyza | Generic: ?

Saxagliptin

Brand Name: Januvia | Generic: ?

Sitagliptin

Brand Name: Cycloset | Generic: ?

Bromocriptine

Name two glinides.

Nateglinide | Repaglinide

Brand Name: Starlix | Generic: ?

Nateglinide.

Brand Name: Prandin | Generic: ?

Repaglinide.

What is the mechanism of action of glinides?

Increase insulin secretion.

What is the mechanism of action of GLP-1 inhibitors? | Four points

- Increases glucose-dependent insulin secretion. - Decreases glucagon secretion. - Slows gastric emptying. - Increases satiety.

Brand Name: Byetta | Generic: ?

Exenatide

Brand Name: Bydureon XR | Generic: ?

Exenatide XR

Brand Name: Victoza | Generic: ?

Liraglutide

What is the mechanism of action of SGLT2 inhibitors?

Increases urinary excretion of glucose.

Brand Name: Invokana | Generic: ?

Canagliflozin

Brand Name: Amaryl | Generic: ?

Glimipiride.

Brand Name: Glucotrol | Generic: ?

Glipizide.

Brand Name: Actos | Generic: ?

Pioglitazone

Brand Name: Avandia | Generic: ?

Rosiglitazone.

Brand Name: Glynase | Generic: ?

Glyburide.

Brand Name: Diabeta | Generic: ?

Glyburide.

Brand Name: Micronase | Generic: ?

Glyburide

What is the mechanism of action of thiazolidinediones? | Two points

- Increases glucose uptake in the muscle and fat. | - Decreases HGP

For diagnosing a pheochromocytoma, which is more reliable... Imaging phenotype or biochemical testing?

Imaging phenotype.

What should the Hounsfield units be if an adrenal mass is suspicious for a pheochromocytoma?

Greater than 20 Hounsfield Units.

What should the contrast washout be if an adrenal mass is suspicious for a pheochromocytoma?

Less than 50% contrast washout at 10 minutes.

Where are epinephrine/metanephrine predominant tumors usually localised to? (Hint: two places)

- Adrenal medulla | - Organ of Zuckerkandl

Where are norepinephrine/normetanephrine predominant tumors usually localised to? (Hint: two places)

- Adrenal medulla | - Sympathetic paraganglioma in the neck, chest, abdomen or pelvis.

What is the TSH target for women before conception?

0.3 - 2.5 mIU/L

What is the TSH target in the first trimester of pregnancy?

0.01 - 2.5 mIU/L

What is the TSH target for the second and third trimester of pregnancy?

0.01 - 3 mIU/L