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GS Medbear > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Thyroid CA with significant family Hx?

A

Medullary CA.
MEN2A/2B - triad of Pheochromocytoma, Parathyroid Hyperplasia, Medullary CA

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2
Q

Which Thyroid CA produces calcitonin and CEA?

A

Medullary CA.
95% produce calcitonin
80% produce CEA

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3
Q

Papillary vs Follicular CA?

A

Papillary lymphatic spread.
Follicular haematogenous spread

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4
Q

Thyroid lymphoma has what strong risk factor?

A

MALT
Hashimoto’s thyroiditis

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5
Q

What tests to order for thyroid?

A

FNAC.
Thyroid function blood test
Tumour markers
US thyroid/neck

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6
Q

Do thyroid pts need pre-op staging CT investigations?

A

Not necessarily.

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7
Q

Why is staging for thyroid CA unique?

A

Age is a factor in determining stage

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8
Q

What tumour markers to test in thyroid test?

A

Thyroglobulin for WDTC (follicular+papillary)
CEA for Medullary

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9
Q

What histo variants in thyroid CA have worse prognosis?

A

Tall cell variant in PTC
Hurthle cell variant in FTC

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10
Q

Risks of total thyroidectomy?

A

Risk of bilateral RLN injury
Permanent HypoPTH

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11
Q

Immediate complications of thyroidectomy?

A
  1. Haemorrhage with hematoma - hematoma forms superficial to strap muscles or deep to the strap muscles.
    Can cause acute airway distress.
  2. RLN, SLN damage
  3. Tracheomalacia
  4. Thyrotoxic storm
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12
Q

How to know if SLN nerve damaged?

A

Cannot create high-pitch sounds

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13
Q

Late complications of thyroidectomy?

A

HypoT
Permanent HypoPTH
Hypertrophic scarring
Tumour recurrence

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14
Q

Wolff-Chaikoff effect?

A

Pt with high doses of Iodine has LOWER T3 + T4 release due to iodine inhibiting TSH action.

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15
Q

Causes of secondary hypoT

A

Hypopituitarism
Isolated TSH deficiency

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16
Q

What does iodine deficiency cause?

A

Nodular goitre, hypoT, cretinism

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17
Q

Number of nodules in thyroid CA types?

A

Papillary - 70% multicentric
Follicular - Solitary
Anaplastic - Large bulky neck mass, mets present
Lymphoma - Rapid enlarging goitre

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18
Q

Which cancer has tall cell variant with worse prognosis?

A

Papillary CA

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19
Q

Which cancer has Hurthle cell variant with worse prognosis?

A

Follicular CA

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20
Q

Which CA is long standing goitre a/w?

A

Anaplastic CA

21
Q

Study for hyperPTH?

A

Tc99mMIBI with SPECT + US neck

22
Q

Why does secondary hyperPTH occur?

A

Due to physiological/appropriate secretion of PTH by normal PTH gland in response to low Ca levels.

23
Q

How does PTH gland present in secondary hyperPTH?

A

Asymmetrical enlargement and nodular hyperplasia of PTH gland.

24
Q

Tertiary hyperPTH?

A

Occurs with long-term secondary hyperPTH causing PTH hyperplasia and autonomous PTH secretion.

25
Q

Causes of tertiary hyperPTH?

A

Chronic Renal Failure
HyperPTH in post-renal transplant patients

26
Q

Thiazides a/w which conditions?

A

HyperCA
HypoNa
HypoK

27
Q

Tests for Cushing’s Syndrome?

A

24hr urinary free cortisol
Low dose dexamethasone suppression test

28
Q

5 Ps for Pheochromocytoma?

A

Pressure
Palpitation
Pain
Perspiration
Pallor

29
Q

Fluctuancy in neck lump suggests?

A

Cystic lesion

30
Q

Thyroid nodules usually located where in neck?

A

Midline

31
Q

How to tell carotid body tumours?

A

Pulsatile!
Lump can be moved sideways but not up and down

32
Q

Commonest cause of hyperCa?

A

PRimary HyperPTH

33
Q

Commonest cause of primary hyperPTH?

A

Parathyroid adenoma.

34
Q

Commonest cause of painful thyroid gland?

A

De Quervain’s thyroiditis

35
Q

Hx of De Quervain’s?

A

URTI preceding thyroid pain,
Low-grade fever 2! to viral infection
Pain worse with swallowing/turning of head
Pain radiate to lower jaw, ear, occiput

36
Q

Symptoms of hyperCa?

A

Constipation, N/V
Increased thirst and frequent urination
Muscle weakness or twitches
Neurological symptoms
Bone pain, osteoporosis

37
Q

Characteristics of thyroid colloid nodule?

A

Central neck lump moves with swallowing but not with tongue protrusion.
FNAC shows normal thyroid follecules

38
Q

What do microcalc on thyroid US represent?

A

Psammoma bodies = PTC

39
Q

Can FTC be diagnosed on FNAC? Why?

A

No. There must be evidence of capsular invasion

40
Q

Patients with Hashimoto’s can initially also present with hyperT symptoms???

A

Yes. Cuz of Hashitoxicosis

41
Q

Rule of 10s in Pheochromocytoma?

A

10% malignant
10% bilateral/multiple
10% children
10% extra-adrenal
10% familial
10% recur
10% incidental

42
Q

Hungry bone syndrome?

A

State of profound HYPOGLYCEMIA that can persist for prolonged periods. Often after parathyroidectomy and thyroidectomy

43
Q

Undiagnostic FNAC + irregular borders can mean?

A

Multinodular Goitre

44
Q

5 signs of Malignancy on thyroid US?

A

borders (irregular)
Internal Vascularity
Taller than wide
Calcification
Hypoechogenicity

45
Q

What imaging to do according to hypoT or hyperT?

A

HyperT = Scintigraphy to check if nodule is hot or cold.
HypoT = US. after US, use ATA guidelines to refer for FNAC

FNAC reporting uses Bethesda system

ATA = American Thyroid Association

46
Q

Bethesda system for reporting thryoid cytopathology?

A

1 = non-diagnostic. Repeat FNA with US guidance.
2 = benign. F/u
3 = atypia. Repeat FNA and monitor
4 = indeterminate for malignancy. Lobectomy or molecular testing in low suspicion group
5 = Suspicious for malignancy
6 = malignant.

5 and 6 need to go near-total thyroidectomy or surgical lobectomy

47
Q

Hot vs Cold nodule on Radio-isotope scan?

A

Hot = absorb RadioIodine. Usu NOT cancerous.
Cold = Do not absorb RadioIodine. 5% risk of being cancerous.
Cold = Proceed to neck US!

Approx. 95% of thyroid nodules are cold

48
Q

Which skin condition has strong association with thyroid autoimmune disorders?

A

Vitiligo

GS Medbear (14 decks)

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