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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
Causes of tertiary hyperPTH?
Chronic Renal Failure HyperPTH in post-renal transplant patients
26
Thiazides a/w which conditions?
HyperCA HypoNa HypoK
27
Tests for Cushing's Syndrome?
24hr urinary free cortisol Low dose dexamethasone suppression test
28
5 Ps for Pheochromocytoma?
Pressure Palpitation Pain Perspiration Pallor
29
Fluctuancy in neck lump suggests?
Cystic lesion
30
Thyroid nodules usually located where in neck?
Midline
31
How to tell carotid body tumours?
Pulsatile! Lump can be moved sideways but not up and down
32
Commonest cause of hyperCa?
PRimary HyperPTH
33
Commonest cause of primary hyperPTH?
Parathyroid adenoma.
34
Commonest cause of painful thyroid gland?
De Quervain's thyroiditis
35
Hx of De Quervain's?
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
Symptoms of hyperCa?
Constipation, N/V Increased thirst and frequent urination Muscle weakness or twitches Neurological symptoms Bone pain, osteoporosis
37
Characteristics of thyroid colloid nodule?
Central neck lump moves with swallowing but not with tongue protrusion. FNAC shows normal thyroid follecules
38
What do microcalc on thyroid US represent?
Psammoma bodies = PTC
39
Can FTC be diagnosed on FNAC? Why?
No. There must be evidence of capsular invasion
40
Patients with Hashimoto's can initially also present with hyperT symptoms???
Yes. Cuz of Hashitoxicosis
41
Rule of 10s in Pheochromocytoma?
10% malignant 10% bilateral/multiple 10% children 10% extra-adrenal 10% familial 10% recur 10% incidental
42
Hungry bone syndrome?
State of profound **HYPOGLYCEMIA** that can persist for prolonged periods. Often after parathyroidectomy and thyroidectomy
43
Undiagnostic FNAC + irregular borders can mean?
Multinodular Goitre
44
5 signs of Malignancy on thyroid US?
borders (irregular) Internal Vascularity Taller than wide Calcification Hypoechogenicity
45
What imaging to do according to hypoT or hyperT?
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 ## Footnote ATA = American Thyroid Association
46
Bethesda system for reporting thryoid cytopathology?
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
Hot vs Cold nodule on Radio-isotope scan?
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
Which skin condition has strong association with thyroid autoimmune disorders?
Vitiligo

GS Medbear (14 decks)

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