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EOR General Surgery > Endocrinology (8%) > Flashcards

Endocrinology (8%) Flashcards

1
Q

Risk factors for thyroid carcinoma with thyroid nodules

A

Extremes of age (very young or > 60 y/o)

History of neck/head radiation

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2
Q

Most thyroid nodules in women are benign, and are either _____ _________ or _______

A

Follicular adenomas

Cysts

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3
Q

Only ___% of thyroid nodules are malignant

A

10%

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4
Q

Most thyroid nodules found in _____ & _____ are malignant

A

Men & children

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5
Q

Most common form of thyroid cancer in women

A

Papillary CA

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6
Q

Symptoms of thyroid nodules

A 
Most are asymptomatic
Worrisome sx: compressive sx
Difficulty swallowing or breathing
Neck, jaw, or ear pain
Hoarseness (rare)
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7
Q

Characteristics of benign thyroid nodules

A

Smooth, firm, regular, sharply outlined, discrete, painless

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8
Q

Characteristics of malignant thyroid nodules

A

Rapid growth
Fixed in place
No movement with swallowing

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9
Q

Diagnostic modalities for thyroid nodules

A
  1. Thyroid Function Tests
  2. FNA with Biopsy - best initial test
  3. Radioactive Iodine Uptake Scan - performed if FNA is indeterminate - cold nodules suspicious for CA
  4. Thyroid ultrasound - often used with FNA
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10
Q

Treatment of thyroid nodules

A
  1. Surgical thyroidectomy - if CA is suspected or if indeterminate FNA w/ cold thyroid scan
  2. Observation of suspicious nodules (every 6-12 mo)
  3. Suppressive therapy with thyroid hormone in attempt to shrink nodule in some cases
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11
Q

Should have increased suspicion of thyroid cancer if patients < ____ y/o with thyroid nodules

A

20 y/o

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12
Q

Two types of thyroid cancer with best prognosis

A

Papillary (Most Common)

Follicular (2nd MC)

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13
Q

Type of thyroid cancer with the worst prognosis

A

Anaplastic (only 10% survive three years after dx)

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14
Q

In papillary thyroid CA, local (cervical) lymph node METS are _________, and distant METS are ________

A

Common

Uncommon

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15
Q

Management of papillary thyroid CA

A

Total thyroidectomy
OR
Subtotal thyroidectomy coupled with radioiodine therapy to destroy residual cells

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16
Q

What can be monitored after thyroidectomy to check for recurrence of thyroid cancer?

A

Thyroglobulin
Monitor for 6 mo
If medullary CA, monitor calcitonin levels

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17
Q

Follicular thyroid cancer is associated with:

A

Iodine deficiency

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18
Q

In follicular thyroid CA, local (cervical) lymph node METS are _________, and distant METS are __________

A

Less common

Common (lung, brain, bone, liver, skin)

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19
Q

Management of follicular thyroid CA

A

Same as papillary

Thyroidectomy or subtotal thyroidectomy with radioiodine therapy

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20
Q

Medullary thyroid CA is associated with:

A

MEN 2

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21
Q

In medullary thyroid CA, local (cervical) lymph node METS occur ______, and distant METS occur _______

A

Early

Late

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22
Q

Management of medullary thyroid CA:

A
  1. Total thyroidectomy - include neck dissection of all lymph nodes
  2. Calcitionin levels used to monitor is residual disease is present after tx or for recurrence
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23
Q

Anaplastic thyroid CA is associated with:

A

Radiation exposure

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24
Q

Anaplastic thyroid CA is most common in:

A

Males > 65 y/o

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25
Q

Symptoms of anaplastic thyroid CA

A

Often will see compressive symptoms

Rapid growth and most aggressive

26
Q

In anaplastic thyroid CA, local (cervical) lymph node METS are _______, and distant METS are _______

A

Common
Also common
May invade trachea!

27
Q

Management of anaplastic thyroid CA:

A

Most not amenable to surgical resection
External beam radiation
Chemotherapy
Palliative tracheostomy in 20% to maintain airway

28
Q

Pts with adrenal carcinoma will often present with _______ _______ and _________

A

Cushing’s Syndrome (fatty hump b/w shoulders, excessive hunger, purple stretch marks)
Virilization (development of male physical characteristics)
Males may present with feminization (breast enlargement, decreased libido)

29
Q

All adrenal tumors that are _______ and/or ________ secreting are malignant until proven otherwise

A

Androgen

Estrogen

30
Q

Diagnostic modalities for adrenal carcinoma

A
  1. Adrenal androgens (DHEA, androstenedione, testosterone and 17-OH)
  2. Elevated levels of estradiol
  3. Incidentally found - screen for aldosteronism, cushings, and pheochromocytoma - if found, remove tumor
31
Q

Management for tumors/nodules found on adrenals incidentally

A

If > 4 cm and non-functioning, remove due to increased risk of CA
If < 4 cm, a CT is warranted every 6 mo

32
Q

Aldosteronism is defined as an increased:

A

Aldosterone:Renin Ratio (20:1)

33
Q

Diagnosis of aldosteronism

A
  1. Aldosterone suppression test w/ oral sodium chloride
  2. Elevated urine aldosterone excretion confirms hyperaldosteronism
  3. Order adrenal CT
34
Q

Diagnosis of Cushing’s syndrome

A
  1. 24 hour urine free cortisol

2. 1 mg overnight dexamethasone test

35
Q

Diagnosis of pheochromocytoma

A
  1. 24 hour urine catecholamines, metanephrines, and normetanephrines
  2. Levels need to be 3x the upper limit of normal for a positive screening
  3. If positive, order adrenal CT
  4. Labs: hyperglycemia, hypokalemia
36
Q

Treatment of adrenal carcinoma

A

Surgical resection is treatment of choice

Glucocorticoid replacement is also needed after resection

37
Q

Catecholamine-secreting adrenal tumor

A

Pheochromocytoma

38
Q

A pheochromocytoma secretes ___________ and ________ autonomously and intermittently

A

Norepinephrine and epinephrine

39
Q

___% of pheochromocytomas are benign

A

90%

40
Q

Signs/Symptoms of pheochromocytoma

A
  1. Hypertension
  2. PHE (Palpitations, Headache, Excessive sweating)
  3. Chest or abdominal pain, weight loss (despite increased appetite)
41
Q

Management of pheochromocytoma

A
  1. Complete adrenalectomy
  2. Preoperative non-selective alpha blocker: Phenoxybenzamine or Phentolamine for 7-14 days
  3. Next, beta blockers or CCBs to control HTN

***** very important to lead with alpha blockers to avoid life threatening hypertension

42
Q

Decreased serum calcium stimulates a release of _____

A

PTH

43
Q

Hyperparathyroidism is most commonly secondary to an ___________

A

Adenoma

44
Q

Most common presentation of hyperparathyroidism

A

Asymptomatic hypercalcemia

45
Q

Symptoms of hyperparathyroidism

A

Bones, stones, abdominal moans, psychic groans

46
Q

Hyperparathyroidism - bone symptoms

A

Osteitis fibrosa cystica, decreased bone mineral density

47
Q

Hyperparathyroidism - stone symptoms

A

Renal stones

48
Q

Most common complication of hyperparathyroidism

A

Renal stones

49
Q

Hyperparathyroidism - abdominal moan symptoms

A

Anorexia
Nausea
Constipation

50
Q

Hyperparathyroidism - psychic groan symptoms

A

Lethargy
Depression
Psychosis

51
Q

Diagnosis of hyperparathyroidism

A 
Labs:
Elevated PTH
Elevated serum calcium
Decreased phosphate
EKG: shortened QT interval
52
Q

Treatment for hyperparathyroidism

A

Surgery is indicated for pts with symptoms
If cannot have surgery:
Cinacalcet or bisphosphonates

53
Q

Indications for surgical intervention in asymptomatic hyperparathyroidism pts

A
  1. Serum calcium over 1.0 mg/dL the upper limit of normal
  2. Reduced creatinine clearance
  3. Osteoporosis
  4. Under 50 years old
54
Q

Most common cause of hyperthyroidism

A

Grave’s disease

55
Q

Signs/symptoms of hyperthyroidism

A 
Heat intolerance
Menstrual irregularities
Weight loss
Palpitations
Hyperdefecation
Anxiety
Tachycardia
56
Q

Grave’s disease specific symptoms

A

Eye proptosis
Chemosis
Lid Retraction
Pretibial myxedema

57
Q

Diagnosis for hyperthyroidism

A
  1. Rule out pregnancies
  2. Thyroid panel (looking for low TSH and high T4)
  3. Radioactive iodine uptake - decreased uptake
    Except in grave’s, which will have increased uptake
58
Q

Treatment for hyperthyroidism

A
  1. Beta blockers
  2. PTU or methimazole
  3. Definitive treatment: radioactive iodine
  4. Steroids for ophthalmopathy
59
Q

Treatment of thyroid storm

A

PTU or methimazole
Beta blockers
High dose corticosteroids

60
Q

Complications of methimazole

A

Leukopenia

Agranulocytosis

61
Q

Complications of PTU

A

Hepatotoxicity

EOR General Surgery (10 decks)

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