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Medicine > Multinodular Goiter > Flashcards

Multinodular Goiter Flashcards

1
Q

Enlarged thyroid gland
Multiple nodules
Disordered growth of thyroid cells
Gradual development of fibrosis

A

Multinodular Goiter

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2
Q

Patient is euthyroid

Enlarged thyroid gland with multiple nodules

A

Nontoxic MNG

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3
Q

Patient is thyrotoxic

1 or more nodules producing thyroid hormone INDEPENDENT of TSH regulation

A

Toxic MNG

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4
Q

Most common MNG

A

Nontoxic MNG

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5
Q

Histologic characteristic of MNG

A

Disordered growth of thyroid cells

Gradual development of fibrosis

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6
Q

MNG epidemiology

Prevalance

Sex

Age

Environment

A

12% adults

W>M

Increases with age

More common in iodine-DEFICIENT regions but also occur in iodine sufficiency

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7
Q

Risk factors for MNG

A

Iodine deficiency
Radiation exposure
Recent exposure to iodine from contrast dyes or other sources may precipitare or exacerbate thyrotoxicosis in toxic MNG

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8
Q

Pathogenesis of MNG

A

genetic
autoimmune
environmental

multifactorial

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9
Q

Major difference between toxic and nontoxic MNG is

A

autonomous production of excess thyroid hormone in the toxic MNG

when toxic MNG develops, it evolves from nontoxic MNG as natural history

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10
Q

Stages of nodular transformation of thyroid

A 
Goitrogenic stimuli (iodine deficiency, autoimmunity, or nutritional goitrogens) 
cause diffuse thyroid hyperplasia
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11
Q

Non toxic MNG signs and symptoms

A

Most are asymptomatic.

Discovered 3 ways:
Goiter with multiple nodules
Incidental finding on CT (substernal goiter)
Enlargement in neck noted by patient

Compressive symptoms in large MNG

Dysphagia (rare)

Plethora venous congestion

Horner’s syndrome

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12
Q

In large goiters obstructing venous return within thoracic aperture

Facial congestion and external jugular vein obstruction when arms are raised above the head

A

Pemberton’s sign

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13
Q

Signs and symptoms may suggest cancer

A 
Pain (hemorrhage into nodule)
Hoarseness (laryngeal nerve involvement)
Stridor
Respiratory distress (tracheal compression)
Tracheomalacia
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14
Q

PE of MNG

A

Thyroid architecture is often distorted with multiple nodules of varying size
Substernal goiters nonpalpable
PE underestimates the goiter size

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15
Q

Laboratory that distinguishes nontoxic MNG from toxic MNG

A

TSH

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16
Q

Imaging is indicated for MNG if

A

Verify hyperfunctioning nodules in a patient with MNG with concomitant clinical/laboratort evidence of hyperthyroidism

Evaluate degree of obstruction in large MNG

17
Q

FNA for MNG is recommended

A

Dominant or enlarging nodule with MNG
Nonfunctioning (COLD) nodules >/= 1.5 cm in diameter
Nodules found to have microcalcifications
Complex architecture on ultrasonography

18
Q

FNA should not be used on

A

Autonomous HOT/warm nodules

19
Q

Thyroid function test if nontoxic MNG

A

Normal TSH

20
Q

Thyroid function test if toxic MNG

A

TSH level is low

Normal or minimally increased FT4

21
Q

CT or MRI of the chest are indicated only when

A

Evaluating goiter anatomy
Substernal extension
Extent of tracheal compression

22
Q

Airway compromise indicates compression of tracheal diameter by how

A

70%

23
Q

Iodinated contrast agents should be administered cautiously to persons with

A

Low TSH

may precipitate underlying hyperthyroidism

consider pretreatment with antithyroid drug before contrast imaging

24
Q

Thyroid scintigraphy (iodine or technetium) should be limited to MNG patients with

A

low TSH

to verify clinical diagnosis of toxic MNG

25
Q

UTZ in MNG is useful for

A

Accurate monitoring of nodule size

Guiding FNA biopsy of suspicious nodules

26
Q

Barium swallow is indicated in MNG

A

To assess whether esophageal compression causes dysphagia

27
Q

FNA biopsy in MNG should be considered for

A 
A dominant nodule >1-1.5cm diameter 
Enlarging nodule with MNG
Nodules with microcalcifications 
Hypoechogenecity
Increased vascularity
Complex architecture
28
Q

Nontoxic MNG treatment

A

Observation if euthyroid in smal nontoxic MNG

29
Q

Treatment for nontoxic MNG is indicated if

A

Obstructive complication
Large or progressively growing goiter
Cosmetic concerns

30
Q

Forms of therapy for nontoxic MNG

A

Total thyroidectomy

To dec size
Radioiodine 132I
Levothyroxine

31
Q

Treatment of toxic MNG is indicated

A

for all patients

3 forms
Total thyroidectomy
Radioiodine treatment
Antithyroid drug therapy

32
Q

Provides most effective and rapid reduction in goiter size of all available therapies

A

Thyroidectomy

Disadvantage
Surgical risk in elderly person with cardiopulmonary disease
Surgical complications
Post-surgical HYPOthyroidism

33
Q

Gradual reduction in goiter size
Safe, outpatient

Can achieve 40-50% reduction of goiter size but patient may have

Transient elevations of thyroid hormone levels within first 2 weeks after therapy

Hypothyroidism may develop

A

Radioiodine therapy

34
Q

Started at low dose since many MNG contain autonomous regions
Avoid excessive TSH supression
Low efficacy
Regrowth after discontinuation of therapy

A

Levothyroxine supression

35
Q

Levothyroxine can precipitate this side effect

A

Subclinical HYPERTHYROIDISM

36
Q

Hyperthyroidism following administration of iodine or iodide as dietary supplement or as iodinated contrast for medical imaging

A

Jod-Basedow effect

37
Q

Autoregulatory phenomenon whereby a large amount of ingested iodine acutely inhibits thyroid hormone synthesis (organification) as well as release within the follicular cells irrespective of the serum level of thyroid-stimulating hormone TSH

A

Wolf-Chaikoff Phenomenon

Hypo

38
Q

Toxic MNG Treatment

A

B blockers
Radioiodine therapy (for areas of autonomy and dec the mass of the goiter)
Thyroidectomy
Antithyroid drugs (euthyroid in 4-6 weeks)

39
Q

Disadvantage of treating toxic MNG with antithyroid drugs alone

A

Therapy is lifelong because hyperthyroidism in toxic MNG does not remit spontaneously

May increase size of goiter

Medicine (29 decks)

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