Lecture 18 (endocrine)-Exam 6 Flashcards
Thyroid Nodules
* What are the two types?
* Prevalence with what?
* When are they found?
Thyroid Nodules
* Clinical importance is primarily related to what?
* Order what?
- Clinical importance is primarily related to the need to exclude thyroid cancer, which accounts for 4 to 6.5 percent of all thyroid nodules
- Order I-123 scan/uptake to see if nodule is hot/cold
What are the benign causes of thyroid nodules?
What are the malignant causes of thyroid nodules?
kinda long-> flow chart
What is the work up for thyroid nodule?
Thyroid nodule dx:
* how do you dx it?
* The thyroid gland requires what to function? Why is this important?
- The radioactive iodine uptake test (RAIU) is also called a thyroid uptake.
- The thyroid gland requires iodine to function. This uptake of iodine is reflective of its function. If the thyroid gland is functioning normally, the quantity of iodine taken up should be within a particular range.
Diagnosis of thyroid nodule
* Radiotracer is either what? What happens to it?
* Radioactive emissions from the radiotracer are what?
* By using radioactive/radiotracer iodine, it is possible to determine what?
* If excessive amount of radioactive iodine is taken up by the gland, it indicates what? What happens if it is a little?
- inhaled as a gas and eventually accumulates in the organ or area of the body being examined.
- Radioactive emissions from the radiotracer are detected by camera and provides molecular information.
- By using radioactive/radiotracer iodine, it is possible to determine how much iodine the thyroid gland pulls in.
- If excessive amount of radioactive iodine is taken up by the gland, it indicates an overactive thyroid gland.
- If very little is taken up, it is indicative of hypothyroidism.
Diagnosis of thyroid nodule
* Radioactive iodine uptake is a measure of what?
* Scintigraphy, on the other hand, is the use of what?
- Radioactive iodine uptake is a measure of the rate of accumulation of radioactive tracer by the thyroid and the ability of it to trap that tracer.
- Scintigraphy, on the other hand, is the use of gamma cameras to capture emitted radiation from internal radioisotopes to create two-dimensional images.
Thyroid Scan: Palpable Nodules on NM scan
* Hot vs cold nodules?
* No uptake?
Hot Nodules
* Essentially always benign
Cold Nodules
* Usually benign but can be malignant
* Majority of nodules are cold (90%)
No uptake
* Infection
Fill in covered part
⭐️Know the most common⭐️
Thyroid Carcinoma
* What are the different types?
- Papillary Carcinoma (60%) ⭐️
- Follicular Carcinoma (20%)
- Anaplastic Carcinoma(1%)
- Medullary Carcinoma(5%)
- Lymphoma(1%)
Thyroid Carcinoma Txt:
* What usually just gets followed?
Patients with benign nodules (macrofollicular or adenomatoid/hyperplastic nodules, colloid adenomas, nodular goiter, and Hashimoto’s thyroiditis) are usually followed without surgery.
Thyroid Carcinoma Txt:
* What is the monitoring for the thyroid nodules that worrisome?
Periodic ultrasound monitoring of benign thyroid nodules initially at 12 to 24 months, then at increasing intervals (eg, two to five years), with the shorter intervals for large nodules or nodules with worrisome ultrasound features and the longer interval for smaller nodules with classic benign ultrasonographic features.
Thyroid Carcinoma US:
* Sonographic features favoring a malignant nodule?
- hypoechoic solid
- presence of microcalcifications: almost always warrants biopsy
- local invasion of surrounding structures
- taller than it is wide
- large size: the cutoff is often taken as 10 mm to warrant biopsy
- suspicious neck lymph nodes suggesting metastatic disease
- intranodular blood flow
Thyroid Carcinoma Treatment:
* Repeat the FNA within 12 months if what?
Repeat the FNA within 12 months if the initial ultrasound shows highly suspicious ultrasound features despite a benign biopsy
Thyroid Carcinoma Treatment:
* Repeat FNA is also warranted when there is what?
Repeat FNA is also warranted when there is substantial growth (more than a 50 percent change in volume or 20 percent increase in at least two nodule dimensions), there is the appearance of suspicious ultrasound features, or new symptoms are attributed to a nodule.
Thyroid Carcinoma Treatment:
* Patients with nodules that are suspicious for malignancy or malignant should be referred for what?
for biopsy vs. removal.
Follow-up and patient education of thyroid cancer
* What needs to be done?
* Need what?
* What type of referral?
- Serial Diagnostic tests as usual
- Need compliance!
- Endocrine referral
What is the pituitary gland anatomy?
Pituitary adenoma