Thryoid Flashcards
Hurthle Cell Cancer treatment
Thyroid storm is manifested by severe tachycardia, fever, confusion, vomiting to the point of dehydration, and adrenergic overstimulation to the point of mania and coma after thyroid resection in a patient with uncontrolled hyperthyroidism. Treatment of a patient with overt thyroid storm includes rapid fluid replacement and institution of antithyroid drugs, beta blockers, iodine solutions, and steroids. In life-threatening circumstances, plasmapheresis or plasma exchange may be effective in reducing T4 and T3 levels.
Non-recurrent RIGHT LN anatomy
A right retroesophageal subclavian artery and an absent innominate artery is part of the arteria lusoria vascular abnormality in patient with a non-recurrent laryngeal nerve on the right.
Non-recurrent LEFT LN
A number of anatomic anomalies must exist in order to have a non-recurrent laryngeal nerve on the left. First, the aortic arch must be right-sided (as occurs in situs inversus viscerum). Second, the origin of the left subclavian artery must be abnormally sited on the aortic arch. Third, the ligamentum arteriosum must be displaced to the right.
Hurthle Cell Cancer findings on FNA
Hürthle cells are frequently present on fine-needle aspiration (FNA) cytology from thyroid nodules. Patients with Hashimoto disease or colloid nodules commonly demonstrate Hürthle cells; however, it is the nodule that contains almost entirely Hürthle cells that raises concern for HCC. If HCC is suggested by FNA cytology, a diagnostic thyroid lobectomy at the minimum is required to definitively establish the nature of the tumor.
Medullary thyroid cancer treatment and LND
Medullary thyroid carcinomas (MTC) 1cm or greater should undergo a total thyroidectomy with central lymph node dissection regardless of clinical nodal status. MTC smaller than one centimeter but with bilobar disease should have a central lymph node dissection.
Thyroidectomy and nerve injury
During a thyroidectomy, the external branch of the superior laryngeal nerve is most commonly injured due to its close proximity of the superior thyroid artery.
Lingual thyroid
Ectopic Thyroid Tissue at the Base of the Tongue, More Commonly Identified When TSH Levels Rise Causing Hypertrophy (Puberty, Pregnancy or Menopause) or no family history, uptake scan, levo or remove
Medullary thyroid cancer in MEN kids
prophylactic total thyroidectomy should be performed before one year of age for MEN IIB and before 5 years of age for MEN IIA.
Graves disease
The patient is presenting with Graves disease, which is an autoimmune process that causes symptoms of hyperthyroidism. In chronic and severe cases, Graves disease can lead to ocular manifestations such as proptosis, eyelid retraction, and lid lag.
Radioactive iodine (RAI) is the most common form of treatment for Graves disease in the United States and is indicated for all patients with mild disease who can tolerate radiation. If the patient has severe thyrotoxicosis with exophthalmos, it is recommended to better control the disease with medications prior to RAI. There is some evidence to suggest that RAI can worsen ocular symptoms associated with Graves disease. Pregnancy and use during breastfeeding are absolute contraindications
Thymus and parathyroid relationship
The thymus arises from the third pharyngeal pouch along with the inferior parathyroid glands. The inferior parathyroid descends with the thymus, but this migration is extremely variable. Inferior glands can be found anywhere from the pharynx to the mediastinum but are typically found within the thymus
Follicular thyroid carcinoma spreads
Follicular spreads far = hematogenous spread; CANNOT be distinguished on FNA
FNA indications
All solid nodules ≥ 1.5 cm require evaluation with FNA. In case of solid nodules ≥ 1 cm , FNA is recommended if sonographic features suspicious for malignancy (hypoechoic, taller than wide in transverse plane, microcalcifications) are present
