Lecture 15: Endocrine Surgery

Question 1

function of endocrine glands

Answer 1

• secrete molecules (hormones) into the bloodstream which act on target cells in distant sites usually to maintain metabolic equilibrium (homeostasis).

Question 2

what are the effects of thyroid hormone?

Answer 2

• increase in carbohydrate/lipid metabolism
• increase protein synthesis
• increase in basal metabolic rate
• growth and maturation

Question 3

what is thyrotoxicosis?

Answer 3

• clinical syndrome of excess circulating thyroid hormones, commonly due to over-secretion of thyroid hormones by the thyroid gland (hyperthryoidism).

Question 4

what are some primary causes of thyrotoxicosis?

Answer 4

• Grave’s disease
• toxic multi-nodular goitre (MNG)
• solitary toxic nodule

Question 5

what are some secondary causes of thyrotoxicosis?

Answer 5

• TSHoma
• excess exogenous T3/4, thyroiditis

Question 6

what are some primary causes of hypothyroidism?

Answer 6

• autoimmune thyroiditis (e.g. Hashimoto’s), dietary insufficieny, surgery, radioiodine

Question 7

what is a secondary cause for hypothyroidism?

Answer 7

pituitary failure

Question 8

List the causes of Goitre

Goitre = enlargement of the thyroid

Answer 8

• genetics
• multi-nodular goitre
• autoimmune thyroid disease
• idodine deficiency
• infiltrative disease - malignancy
• TSHoma

Question 9

WHO classification of Goitre

Answer 9

• 0: impalpable, invisible
• 1: palpable, invisible on extension
• 1b: palpable, visible on extension
• 2: visible
• 3: visible at a distance

Question 10

list the complications of thyroidectomy

Answer 10

• bleeding
• voice change - damage to recurrent laryngeal nerve
• hypocalcaemia - temporary and permanent (hypoparathyroidism)
• long-term thyroid supplements
• wound problems
• aspiration (swallowing problems)
• dyspnea
• redo surgery

Question 11

what are the four types of thyroid cancer? and their associated prognosis

Answer 11

• papillary (usually good prognosis)
• follicular (usually good prognosis)
• medullary
• anaplastic (very poor prognosis)

Question 12

medullary thyroid cancer arises from which cells?

Answer 12

calcitonin-secreting C-cells

Question 13

what are the most common primary disorders of parathyroid glands?

Answer 13

• adenoma (80-90%)
• hyperplasia (10-20%)
• carcinoma (1%)

Question 14

list the features of Conn’s syndrome

Answer 14

• hyperaldosteronism
• increased Na+ absorption by distal tubule and collecting duct of the nephron and increased K/H excretion
• increased ECF volume
• hypertension +/- hypokalaemia