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Abd / SS 3 > Module 2 : Thyroid > Flashcards

Module 2 : Thyroid Flashcards

1
Q

what is the shape and location of the thyroid

A
  • butterfly shape

- base of neck

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2
Q

how are the two lobes of the thyroid connected

A
  • with an isthmus
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3
Q

is one lobe of the thyroid bigger than another

A
  • yes it is common

- right often bigger

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4
Q

does the thyroid have a capsule

A
  • yes enclosed by a fibrous capsule
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5
Q

where is the trachea in relation to the thyroid

A
  • sits between the two lobes of the thyroid
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6
Q

what is a pyramidal lobe

A
  • fetal remnant
  • third lobe
  • extends superiorly from the isthmus
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7
Q

what three things can change the size and shape of the thyroid

A
  • gender
  • age
  • body habitus
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8
Q

what gender has slightly larger thyroids

A
  • females
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9
Q

what is the normal length of the thyroid

A

4-6cm

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10
Q

what is the normal AP of the thyroid

A

2cm

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11
Q

what is the normal width of the thyroid

A

2cm

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12
Q

what is the normal measurement of the isthmus

A

2-6mm

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13
Q

where is the CCA and IJV located in relation to the thyroid

A
  • lateral to lobes and posterior

- CCA medial to IJV

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14
Q

where is the esophagus located in relation to the thyroid

A
  • posterior and slightly left of the trachea

- anterior to the spine

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15
Q

where is the longs Colli located in relation to the thyroid

A
  • posterior to the lobes and cca
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16
Q

where is the SCM located in relation to the thyroid

A
  • anterolateral
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17
Q

where are the strap muscles located in relation to the thyroid

A
  • anterior
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18
Q

what is contained in the neurovascular bundle and where is it location related to the thyroid

A
  • inferiori thyroid artery and laryngeal nerve

- posterior to thyroid

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19
Q

where are the parathyroid glands located in relation to he thyroid

A
  • posterior
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20
Q

is the thyroid vascular or avascular

A
  • highly vascular
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21
Q

what are the vessels that feed the thyroid and where do they originate from

A
  • right na left superior thyroid artery (branches of ECA)

- right and left infer thyroid arteries (branches of subclavian arteries)

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22
Q

what are the vessel that drain the thyroid. and what vessels do they drain into

A
  • superior and middle thyroid veins (into IJV)

- inferior thyroid vein (into innominate vein)

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23
Q

what is the lymphatic drainage fo the thyroid

A
  • drained via the deep cervical lymph nodes around the carotids
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24
Q

where is the most common site for thyroid cancer to metastasize

A
  • deep cervical lymph nodes
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25
Q

what is the normal ultrasound appearance of the thyroid

A
  • homogenous
  • medium level echo
  • hyperechoic thin capsule
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26
Q

what is the functional unit of the thyroid

A
  • follicle
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27
Q

what hormones are produced by the thyroid follicle

A
  • T3 and T4
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28
Q

what is contained within the lumen of the follicle and what is its purpose

A
  • colloid

- gelatinous substance that stores T3 and T4

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29
Q

what structure within the follicle produces the calcitonin

A
  • parafollicular cells
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30
Q

what is the purpose of calcitonin

A
  • helps regulate the bloods calcium levels and phosphate levels
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31
Q

what kind of gland is the thyroid

A
  • endocrine
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32
Q

what are the three purposes of the thyroid when it comes to hormones

A
  • synthesizes
  • stores
  • secretes
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33
Q

what is the main function of the thyroid

A
  • regulates the metabolism
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34
Q

what are the there hormones the thyroid produces

A
  • thyroxine T4
  • triiodothyronine T3
  • calcitonin
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35
Q

what due T3 and T4 effect in the body

A
  • metabolic rate
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36
Q

what element from our diet synthesizes T3 and T4

A
  • iodine
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37
Q

what is the function of the calcitonin

A
  • maintains homeostasis of blood calcium
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38
Q

how does calcitonin maintain homeostasis of blood calcium

A
  • decreases concentration of blood calcium

- inhibits the breakdown of bone by osteoclasts

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39
Q

how is the maintenance of circulating concentrations of T3 and T4 achieved

A
  • NEGATIVE FEEDBACK SYSTEM
  • drop in circulating T3 and T4 decreases the basal metabolic rate BMR
  • a falling BMR stimulates TRH (thyrotropin releasing hormone) from the HYPOTHALMUS
  • this provokes release fo TSH (thyroid stimulating hormone) from the PITUITARY
  • this causes the thyroid to release more T and T4
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40
Q

what is euthyroid

A
  • normal function thyroid
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41
Q

what is hypothyroidism

A
  • under secretion of thyroid hormones resulting in decreased body metabolism
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42
Q

what three things are cause and under secretion of thyroid hormone

A
  • low intake of iodine
  • dysfunction of gland
  • pituitary gland abnormality
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43
Q

what are the 7 signs and symptoms of hypothyroidism

A
  • weight gain
  • hair loss
  • lethargy
  • cold intolerance
  • deep husky voice
  • constipation
  • increased subcutaneous tissue around the eyes
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44
Q

what are the 4 causes of hypothyroidism

A
  • hashimotos
  • iodine deficiency
  • partial thyroidectomy
  • pituitary gland problems affecting TSH production
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45
Q

what is the most common cause of hypothyroidism in North America

A
  • hashimotos
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46
Q

what is the most common cause of hypothyroidism worldwide

A
  • iodine deficiency
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47
Q

what is hyperthyroidism

A
  • over secretion of hormones resulting in increased body metabolism
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48
Q

what are 2 things that cause over secretion of thyroid hormones

A
  • entire thyroid gland over functioning

- neoplasm producing excess hormones

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49
Q

what are the 8 signs and symptoms of hyperthyroidism

A
  • weight loss
  • increased appetite
  • nervousness
  • excessive sweating
  • heat intolerance
  • palpitations
  • fatigue at the end of day
  • exophthalmos
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50
Q

what are the 5 causes of hyperthyroidism

A
  • graves diseases (with goiter)
  • toxic adenoma
  • inflammation of the thyroid
  • excessive thyroid medication
  • pituitary tumors
51
Q

what are the 4 lab tests that can be done to test thyroid function

A
  • serum T3
  • serum T4
  • serum TSH
  • thyroid antibodies
52
Q

what is the other imaging method of the thyroid

A
  • thyroid scan
    + nuke med test determines function
    + hot and cold nodules
53
Q

what does a hot nodule mean in a nuke med scan

A
  • hot&raquo_space; hyper-functioning» benign
54
Q

what does a cold nodule mean in a nuke med scan

A
  • cold&raquo_space; nonfunctioning&raquo_space; possible malignancy
55
Q

what are the 4 for a thyroid scan

A
  • increased in gland size (symmetric or asymmetric)
  • change in metabolism
  • cold nodule on NM scan
  • palpable lump
56
Q

what are the two categories of benign thyroid pathology

A
  • benign focal

- bengin diffuse

57
Q

what are the 3 benign focal thyroid pathologies

A
  • cysts
  • thyroglossal duct cyst
  • adenomas
58
Q

are true thyroid cysts rare or common

A
  • rare
59
Q

what are thyroid cysts more commonly a representation of

A
  • cystic degeneration of a follicular adenoma
60
Q

when can hemorrhagic cysts be identified in the thyroid

A
  • blunt trauma to neck

- acute hemorrhage of adenoma

61
Q

what is the sonographic appearance of thyroid cysts

A
  • simple = anechoic
  • complex = internal echoes irregular walls
  • colloid cyst = echogenic with COMET TAIL ARTIFACT
62
Q

what type of anomaly is a thyroglossal duct cyst

A
  • congenital
63
Q

where is a thyroglossal duct cyst located

A
  • midline of neck

- anterior to trachea

64
Q

what is a thyroglossal duct cyst

A
  • remnant of tract that fails to atrophy
65
Q

sonographic appearance of thyroglossal duct cyst

A
  • fusiform cystic structure less than 3cm in size
66
Q

what is an adenoma

A
  • a benign neoplasm with a capsule
67
Q

which gender is more commonly affected by adenomas

A
  • women
68
Q

what is the most common type of adenoma

A
  • follicular adenoma
69
Q

are adenomas more symptomatic or asymptomatic

A
  • asymptomatic
70
Q

are adenomas hot or cold on nuke med

A

cold

71
Q

what is the sonographic appearance of a thyroid adenoma

A
  • anechoic>isoechoic>hyperechoic
  • solitary defined round or oval
  • hypoechoic halo
  • eggshell calcifications
72
Q

what are the two categories of diffuse benign thyroid disease

A
  • inflammatory

- hyperplasia

73
Q

what is the inflammatory benign diffuse diseases

A
  • thyoirditis

- swelling tenderness of gland with fever

74
Q

is thyroiditis more commonly found in men or women

A
  • women
75
Q

what are the 5 types of thyroiditis

A
  • haschimotos
  • acute supperative
  • subacute granulomatous
  • silent
  • invasive fibrous
76
Q

what is hashimotos thyroiditis

A
  • chronic lymphocytic inflammatory disease

- autoimmune

77
Q

what is the most common cause of adult hypothyroidism

A
  • hashimotos
78
Q

what gender is more effected by diseases of the thyroid

A
  • women
79
Q

is hashimotos painful or painless

A
  • painless
80
Q

what lab value would be effected with hashimotos

A
  • antithyroid antibodies
81
Q

what is associated with hashimotos

A

increased risk of developing lymphoma

82
Q

what is the ultrasound appearance of hashimotos

A
  • diffuse heterogenous enlargement of gland
  • hypoechoic
  • discreet nodules of calcifications
  • indistinguishable from multi nodular goiter
  • hyper vascular in acute phase
  • cervical lymphadenopathy
83
Q

in what patients is acute suppurative thyroiditis most common

A

children

84
Q

what are the signs and symptoms of acute suppurative thyroiditis

A
  • firm painful thyroid

- low grade fever and sore throat

85
Q

what type of infection causes acute suppurative thyroiditis

A

bacterial

86
Q

ultrasound appearance of acute suppurative thyroiditis

A
  • diffuse enlargement
  • hypoechoci
  • possible abscess
87
Q

what is another name for subacute granulomatous thyroiditis

A
  • de quervain thyroiditis
88
Q

what type of infection causes subacute granulomatous

A
  • viral
89
Q

what are the signs and symptoms of subacute granulomatous

A
  • gland swells rapidly, very painful and tender

- hyperthyroidism

90
Q

ultrasound appearance of subacute granulomatous

A
  • enlarged gland
  • hypoechoic
  • normal or decreased vascularity
91
Q

characteristics of silent thyroiditis

A
  • enlarged gland with no pain
  • sonographically resembles hashimotos
  • clinically resembles subacute granulomatous
92
Q

characteristics of invasive fibrous (riedels struma)

A
  • rarest form
  • results in complete destruction of thyroid
  • enlarged heterogenous thyroid
  • inflammatory process can extend extra thyroid
93
Q

what does thyroid hyperplasia mean

A
  • goiter
94
Q

what are the causes of hyperplasia

A
  • iodine deficiency

- defect in normal hormone synthesis

95
Q

what is graves disease

A
  • diffuse toxic goiter (thyrotoxicosis)
  • hyperthyroidism
  • autoimmune disease
96
Q

is graves disease rare or common

A
  • common
97
Q

what are 3 clinical features of graves disease

A
  • exophthalmos
  • skin thickening at low extremities
  • clubbed toes and fingers
98
Q

ultrasound appearance of graves disease

A
  • diffuse symmetrical enlargement
  • lobulated
  • homogenous or heterogeneous
  • hypoechoic
  • thyroid inferno (hyper vascular)
99
Q

what is a non toxic goiter

A
  • endemic or sporadic
  • related to lack iodine in the diet
  • no functional disturbances
100
Q

ultrasound appearance of non toxic goiter

A
  • diffusely and uniformly enlarged
  • smooth or nodular echotexture
  • not as large as multi nodular goiter
101
Q

what’s a multi nodular goiter

A
  • adenomatous
  • iodine deficiency
  • iodine deficiency results in inadequate thyroid hormone production» pituitary gland releases more TSH» causes thyroid gland to enlarge
102
Q

ultrasound appearance of multi nodular goiter

A
  • enlarged often asymmetrical
  • diffusely heterogenous with multiple nodules
  • calcifications with cystic areas
103
Q

are solitary nodules or multiple nodules more suspicious of malignancy

A
  • solitary
104
Q

what is needed for diagnosis of thyroid malignancy

A

FNA

105
Q

signs and symptoms of malignant thyroid disease

A
  • pressure symptoms = difficulty breathing or swallowing
  • painless palpable neck mass
  • change in voice
106
Q

ultrasound appearance of malignant diseases

A
  • variable
  • hypoehcoic
  • poorly defined borders
  • jagged borders
  • absence of halo or incomplete halo
  • micro calc
  • taller than wide
  • enlarged nodes.
107
Q

what are the 6 types of thyroid malignancy

A
  • papillary
  • follicular
  • medullary
  • anaplastic
  • lymphoma
  • metastases
108
Q

what is the most common thyroid malignancy

A
  • papillary carcinoma
109
Q

what is the least aggressive thyroid malignancy

A
  • papillary carcinoma
110
Q

is papillary carcinoma slow or fast growing

A
  • slow growing but can spread
111
Q

is papillary carcinoma symptomatic or asymptomatic

A
  • asymptomatic
112
Q

ultrasound appearance of papillary carcinoma

A
  • solid
  • hypoechoic
  • microcalcs
  • tiny
  • hyper vascular
113
Q

is follicular adenoma more aggressive than papillary and how does it grow

A
  • slow growing

- more aggressive&raquo_space; mets to lung and bone

114
Q

what increases risk of follicular adenoma

A
  • history of radiation
115
Q

ultrasound appearance of follicular adenoma

A
  • enlarge encapsulated nodule with irregular borders thick halo and possible microcalcifications
116
Q

characteristics of medullary carcinoma

A
  • hard bulky mass
  • men = women
  • pheochromocytomas
  • metastasize readily
  • secrete calcitonin
117
Q

ultrasound appearance of medullary carcinoma

A
  • solid
  • hypoechoic
  • well circumscribed
  • encapsulated
  • coarse calc
118
Q

characteristics of anaplastic carcinoma

A
  • rarest
  • most aggressive
  • older patients
  • invades adjacent structures
  • death by compression asphyxiation
119
Q

ultrasound appearance of anaplastic carcinoma

A
  • hypoechoci
  • solid
  • irregular
  • encasing/invading blood vessels
  • neck muscles
120
Q

characteristics of lymphoma

A
  • primarily non Hodgkins
  • older females
  • rapidly growing mass
  • history of hashimotos
121
Q

ultrasound appearance of lymphoma

A
  • hypoechoic
  • lobulated
  • non vascular
122
Q

characteristics of metastases to the thyroid

A
  • infrequent
  • spread through hematogenous route
  • breast lung colon melanoma
123
Q

what are 5 common associated features of benign thyroid lesions

A
  • regular well defined borders
  • thin hypoechoic halo
  • solitary or multiple minute cysts within mass
  • hyperechoic
  • large calc around periphery
124
Q

what are 3 common associated features of malignant thyroid lesions

A
  • irregular borders
  • absence of halo
  • micro calc

Abd / SS 3 (6 decks)

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