Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Appendix > Thyroid 2 > Flashcards

Thyroid 2 Flashcards

1
Q

Most common cause of hyperthyroidism in North America?

A

Grave’s (diffuse toxic goiter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Women vs men, who is more affected by Grave’s?

A

women 20-40 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cause of Grave’s dx?

A

autoimmune disorders

antibodies against TSH-R

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Classic triad of sx of Graves?

A

sxs of thyrotoxicosis

enlarged neck mass with bruit due to increased flow

exopthalmos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophys of Grave’s dx;

A

autoantibodies stimulate TSH-receptor, more thyroid hormone is made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Grave’s assc with other autoimmune d/o like?

A

Addison’s
DM1
pernicious anemia
myasthenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When testing for hyperthyroidism what lab values do we usually see?

A

suppressed TSH

elevated T3/T4

***if eye symptoms not present, can do an I 123 uptake scan, an elevated uptake with diffuse enlarged gland confirm Grave’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What foot findings do we find with Grave’s?

A

pretibial myxedema

due to deposition of glycosaminoglycans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx for Grave’s?

A

anti-thyroid meds
radio-iodine ablation
thyroidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What anti-thyroid meds used for Grave’s?

A

PTU 100-300 mg 3x/day

methimazole 10-30 mg 3x/day then 1x/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do methimazole and PTU work in pt’s with hyperthyroidism due to Grave’s?

A

methimazole–> reduce thyroid production by inhibiting thyroid binding iodine

PTU–» same thing, also prevents conversion of peripheral T4 to T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which anti-thyroid medication preferred in pregnant pts?

A

both drugs can cross placenta and inhibit fetal thyroid function

both excreted in breast milk

methimazole assc with congenital aplasia

**PTU has lower risk of trans-placental transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Methimazole or PTU for anti-thyroid medication in pregnant pts?

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Side effects of PTU and methimazole?

A

agranulocytosis and aplastic anemia ***rarely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The catecholamine response of thyrotoxicosis can be mediated by administering what drug?

A

b-blocker propranolol

**CCBlockers can be used in pts where BB contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA of PTU and methimazole?

A

inhibit organification of intra-thyroid iodine as well as coupling of iodotyrosine molecules to fomr T3 and T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tx of choice for Grave’s dx is US?

A

radioiodine ablation with I 131

90% success rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most pt’’s with hyperthyroidism are candidates for radioiodine ablation, except?

A

pregnant women
women who are lactating

those with a suspicious nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is thyroid storm?

A 
severe tachycardia
fever
confusion
vomiting
adrenergic overstimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx for thyroid storm?

A 
rapid fluid replacement
antithyroid drugs
beta blockers
iodine solutions
steroids

**in life threatening situations, peritoneal vs hemodialysis to get rid of T4 and T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Plummer’s dx?

A

hyperthyroidism from a single hyperfunctioning nodule that is autonomous (toxic adenomas)

usually seen in younger pts w/recent growth of a nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Toxic adenomas, which are usually single solitary nodules that are hyperfunctioning, don’t produce sx of hyperthyroidism until they get to what size?

A

> 3 cm

**show uptake of iodine, deemed “hot”

**these nodules rarely malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx for toxic adenomas?

A

for small nodules can be managed with antithyroid meds or radiodine abalation

larger nodules need surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What causes thyroid storm?

A 
abrupt cessation of antithyroid meds
infections
thyroid/non-thyroid surgery
trauma in pts w/underlying thyrotoxicosis 
following amiodarone administration
iodine containing contrasts
RAI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx for thyroid storm?

A

b-blocker; propranolol–> decrease hyperthyroid sxs, reduce conversion of T4 to T3

Tylenol for fever

supplemental O2

Lugol’s idoine or sodium ipodate —> decrease iodine uptake and thyroid hormone secretion

PTU–> reduces T4 to T3 conversion

steroids for the adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What % of thyroid nodules are cancerous?

A

5-15% are cancerous

most are benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Risk factors for malignancy when evaluating thyroid nodules?

A

children
males
age < 30, > 60
radiation exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

US findings of a nodule that are considered suspicious for malignancy?

A 
microcalcifications
hypervascular
infiltrative margins
hypoechoic compared to surrounding tissue
shape is taller than its width
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What’s the size cutoff for evaluation of thyroid nodules?

A

nodules <1 cm are usually not followed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Malignancy rates in hot vs cold nodules:

A

hot nodules; 5-10%

cold nodyles: 15-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

This cancer accounts for 80% of all thyroid malignancies:

A

papillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most common thyroid cancer?

A

papillary (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most common to least common thyroid cancers;

A

papillary 80%
medullary 6%
Anaplastic 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Papillary thyroid cancer tends to affect men or women more?

A

2;1 women

mean age of presentation 30-40 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Distant mets of papillary carcinoma are rare at presentation, but tend to develop in 20% of pts, where?

A

lungs*** then

bone
liver
brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How do we diagnose papillary thyroid Ca?

A

FNA of thyroid mass or lymph node

after diagnosis made, neck US recommended to look at other half of lobe, and to look for central, lateral neck compartment nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most frequent genetic alteration in papillary thyroid Ca?

A

PTC-RET proto-oncogene

encodes for a receptor tyrosine kinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Prognosis of papillary thyroid Ca?

A

excellent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most important risk factor for papillary thyroid Ca?

A

radiation exposure as child

**commonly seen in women, 30-50 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Orphan Annie nuclei and Psammoma bodies seen with which type of thyroid Ca?

A

papillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Two distinguishing features of papillary thyroid Ca?

A

psammoma bodies

orphan Annie nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In this type of thyroid Ca, cells are cuboidal, with abundant cytoplasms, crowded nuclei that show grooving, and intranuclear cytoplasmic inclusions;

A

papillary Ca—> orphan annie nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

These are microscopic calcified deposits of sloughed off cells seen in papillary thyroid Ca;

A

psammoma bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Surgical tx for papillary thyroid Ca?

A

> 1 cm near total or total thyroidectomy recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Scoring systems for thyroid Ca?

A

AMES; age, mets, extent of primary tumor, size of tumor

AGES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Most important prognostic factor or thyroid Ca?

A

age at diagnosis (< 40 ass w/better prognosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How does papillary ca typically spread?

A

lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Tx of papilalry thyroid Ca less than 1 cm?

A

with no involved LNs
no hx of radiation

lobectomy + isthmusectomy is appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tx of papillary thyroid Ca >1 cm, or <1 cm with + LNs, hx of radiation?

A

near or total lobectomy followed by RAI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

If someone has a papillary thyroid Ca, and positive central lymph nodes, whats tx?

A

level VI; central lymph node dissection w/total or near-total thyroidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Follicular thyroid Ca, makes up what % of thyroid Cancers?

A

10%

52
Q

What % of thyroid cancers are follicular?

A

10%

53
Q

What’s Hurthle cell carcinoma?

A

variant of follicular type cancer

54
Q

Men or women affected more by follicular thyroid cancer?

A

women, 3;1

55
Q

Which pts are affected by Hurthle cell carcinoma, a variant of follicular carcinoma?

A

older pts; 60-75

56
Q

Is follicular ca associated w/radiation exposure?

A

none

57
Q

For a histological diagnosis of follicular ca of thyroid what do we need?

A

follicular cells need to occupy abnormal positions such as capsular, lymphatic, and vascular invasion

two types of follicular ca exist; minimally vs widely invasive

lymph node involvement is unusual in follicular ca (compared to papillary)

58
Q

Pts w/follicular cancer of thyroid tends to have mets to where?

A

lung
bone
brain

59
Q

How does follicular ca of thyroid spread?

A

HEMATOGENOUSLY

unlike papillary which spreads via LNs

60
Q

Papillary thyroid cancer spreads lymphatically, while follicular Ca of thyroid spread via:

A

blood

61
Q

How do we diagnose follicular ca of thyroid?

A

FNA is not effective, intra-op frozen section is also not effective

you need to see cellular invasion of the capsule or vascular or lymphatic channels

62
Q

Follicular Ca of thyroid tends to mets to where?

A

lytic bone lesions

lung

63
Q

What is the most important predictor of survival for follicular Ca of thyroid?

A

age

younger the better

64
Q

Tx for follicular ca of thyroid?

A

<2 cm lesion, well contained within 1 thyroid lobe; thyroid lobectomy, isthmusectomy

> 2 cm lesion; total thyroidectomy

**post-surgically you need radio-active iodine ablation with I 131 and long term monitoring of Tg

65
Q

Hurthle cell is a variant of follicular ca of thyroid seen in elderly pts, how is it different?

A

more aggressive

worse prognosis than FTC

poor iodine uptake–> RAI less effective

higher rate of recurrence than FTC

66
Q

This thyroid Ca stems for the parafollicular C cells of the thyroid, located in the upper poles of the thyroid:

A

medullary thyroid Ca

67
Q

What causes medullary thyroid Ca?

A

originates from parafollicular C cells of neural crest origin

68
Q

How is medullary thyroid cancer inherited?

A

***80% occur in sporadic form

rest are inherited in AD pattern; MEN2A, MEN2B and familial medullary thyroid cancer

69
Q

What clinical features are diagnostic of medullary thyroid cancer?

A

elevated calcitonin levels

presence of a thyroid mass

70
Q

What gene is affected in MEN syndrome, assc w/medullary thyroid Ca?

A

RET proto-oncogenes

71
Q

Prior to considering intervention in pts with medullary thyroid cancer, what needs to happen first?

A

need to rule out a pheochromocytoma

72
Q

MEN1?

A

pituitary adenoma
parathyroid hyperplasia
pancreatic neoplasia

73
Q

MEN2A?

A

parathyroid hyperplasia

medullary thyroid Ca
pheochromocytoma

74
Q

MEN2B?

A

medullary thyroid Ca

mucosal neuromas
marfan habitus
pheochromocytoma

75
Q

Tx for medullary thyroid Ca?

A

at least a total thyroidectomy

76
Q

Tx for pts with MEN2B RET mutations should have what type of surgery?

A

prophylactic total thyroidectomy within first year of life

77
Q

Anaplastic thyroid Ca, makes up what % of thyroid cancers?

A

1%

78
Q

1% of all thyroid Ca are what type?

A

anaplastic

79
Q

Most aggressive form of thyroid Ca?

A

anaplastic

80
Q

An older pt with dysphagia, rapidly expanding neck mass, painful, cervical tenderness, we think of what thyroid Ca?

A

anaplastic

81
Q

At the time of diagnosis, 90% of this thyroid Ca has distant mets:

A

anaplastic

82
Q

Primary thyroid lymphomas are rare, occurring more frequently in women, how do they present?

A

hoarseness
dysphagia
fever
rapidly growing goiter

83
Q

Thyroid lymphomas are almost all non-Hodgkin’s lymphoma of what cell variety?

A

B cell type

84
Q

Chemo treatment for lymphoma of thyroid?

A

CHOP

cyclophosphamide
doxorubicin
vincristine
prednisolone

85
Q

Tx for lymphoma of thyroid?

A

CHOP + surgical thyroidectomy

86
Q

When performing thyroid surgery, where do you make your initial incision?

A

2 fingerbreadths above clavicle; tranverse incision

lateral borders of the incision should be medial borders of SCM

but the incision can be extended if needed

incision carried thru skin and subQ fat and platysma, superior and inferior skin flaps are raised
anterior jugular vein identified; middle jugular vein cut

87
Q

Common complications after thyroidectomy?

A

hypocalcemia from devascularization of parathyroids

hoarseness due to recurrent laryngeal nerve damage

88
Q

How to avoid hypocalcemia by avoiding parathyroid devascularization?

A

auto-transplant of 1 mm fragments of saline chilled tissue into pockets made in SCM or brachioradialis muscle

89
Q

Superior laryngeal nerve damage does what?

A

internal branch–> sensory to larynx

external branch–> runs close to superior thyroid artery, motor to circothyroid, tenses vocal cords

damage leads to poor volume, fatigue, can’t sing at higher pitches, huskiness

90
Q

Unilateral recurrent laryngeal nerve injury?

A

a paralyzed vocal cord, loss of movement from midline

91
Q

With RAI, when used to treat Grave’s dx, what side effect can we see?

A

hypothyroidism

92
Q

Strongest prognostic factor when evaluating someone with thyroid Ca?

A

AGE

93
Q

What gives rise to the neural crest cells which cause medullary thyroid Ca?

A

4th pharyngeal pouch develops into the ultimobranchial bodies early in thyroid development

these neural crest cells then become the parafollicullar C cells

94
Q

For medullary thyroid cancer, what can we use as a surveillance marker for recurrence following resection?

A

calcitonin levels

95
Q

When do we perform a thyroid lobectomy for follicular carcinoma?

A

lobectomy is sufficient is nodule less than 4 cm

pt is under 45

no signs of distant mets

pt has no personal/family hx of thyroid Ca

**lobectomy allows most of these pts to remain euthyroid post-surgery

96
Q

Do we perform neck dissections for follicular Ca?

A

no, nodal involvement is unlikely

disease spreads hematogenously

97
Q

Surgical tx for medullary thyroid Ca?

A

documented medullary thyroid Ca needs a total thyroidectomy with b/l level VI central LN dissection

if nodes are positive, needs a lateral neck dissection needed on that side

98
Q

When do we perform prophylactic thyroidectomy for pts with medullary thyroid Ca associated w/ MEN2A, MEN 2B:

A

MEN2A–> before 5 year old

MEN2B–> before 1 year old

99
Q

These are round laminated calcifications in the core of papillae:

A

psammoma bodies assc/ w papillary thyroid Ca

100
Q

Describe psammoma bodies seen in papillary thyroid Ca:

A

round laminated calcifications seen in the core of papillae

101
Q

Most significant risk factor for papillary thyroid Ca?

A

radiation exposure as a child

102
Q

Bethesda classifications after FNA?

A

1– non-diagnostic–> repeat FNA

2–benign

3–follicular lesion of undetermined significance–> repeat FNA

4–follicular lesion–> genetic eval vs lobectomy

5–suspicious for malignancy–> lobectomy vs thyroidectomy

6–malignant–> total thyroidectomy

103
Q

How does papillary thyroid cancer spread?

A

lymphatics

104
Q

For most pts treatment of Hashimoto’s thyroiditis is handled with levothyroxine in those with hypothyroidism, when do we perform surgery?

A

pts w/large goiters

pts w/ significant compressive symptoms

sxs refractory to levothyroxine

inability to rule out malignancy

105
Q

Long-standing neck mass, rapidly enlarges, assc w/ dysphagia, dysphonia, and dyspnea;

A

anaplastic thyroid Ca

106
Q

Most pts w/anaplastic thyroid Ca die of what?

A

superior vena cava syndrome

asphyxiation

exsanguination

107
Q

Most common location for an ectopic superior parathyroid gland is?

A

tracheo-esophageal groove

108
Q

Most common location for an ectopic inferior parathyroid gland is?

A

thymus

109
Q

Most common location for a missed parathyroid gland?

A

normal anatomic location

110
Q

What are Delphian lymph nodes in thyroid ca?

A

central compartment lymph nodes; VI

111
Q

Rotter’s lymph nodes?

A

located between pec major and pec minor

112
Q

Most common form of thyroid Ca?

A

papillary

113
Q

Cuboidal cells with pale abundant cytoplasm; large crowded nuclei with folded and grooved nuclear margins w/ intranuclear cytoplasmic inclusions:

A

orphan annie eyes

psammoma bodies

seen in papillary thyroid ca

114
Q

Hurthle cell is an aggressive variant of follicular Ca, what do we see histologically?

A

increased number of mitochondria with an enlarged, granular, granular eosinophilic cytoplasm

115
Q

How do we treat thyroid cancer during pregnancy?

A

well differentiated papillary/follicular ca without nodal spread, mets, or rapid growth–> post-partum surgery

poorly differentiated Ca like medullary, w/rapid growth, nodal involvements, mets–> surgery 2nd trimester

anaplastic ca, severe compressive sx–> immediate surgery

116
Q

Radioactive iodine is contraindicated in pregnant pts, why?

A

I 131 can destroy the fetal thyroid gland

117
Q

Tx for well differentiated thyroid cancer like papillary during pregnancy?

A

if no nodal involvement, no mets, not rapidly growing–> post-partum surgery

if nodal involvement, mets, rapidly growing–> 2nd tri

118
Q

Mainstay of treatment for thyroid lymphoma is?

A

chemo & radiation

119
Q

Most thyroid lymphomas are rare, most classified as non-hodgkin’s lymphomas (B cell origin) and almost all develop in setting of?

A

hashimoto’s thyroiditis

120
Q

In pts w/suspected thyroid lymphoma, why do we usually see elevated levels of anti-thyroid peroxidase and anti-thyroglobulin antibodies?

A

strongly assc/w Hashimoto’s

121
Q

What nerve most likely to be injured during a thyroidectomy?

A

external branch of superior laryngeal nerve

runs close w/ superior thyroid artery

122
Q

The thymus and the inferior parathyroids arise from what pouch?

A

3rd pharyngeal pouch

123
Q

Ultimobranchial body and superior parathyroids arise from what pouch?

A

4th pharyngeal pouch

124
Q

Pts w/severe Grave’s opthalmopathy should be managed with?

A

thionamides vs total thyroidectomy

**radioactive iodine worsens Grave’s opthalmopathy

125
Q

DeQuervain’s thyroiditis or subacute thyroiditis typically occurs following what?

A

viral URI

Tx–> ASA/NSAIDs/ steroids

126
Q

Tx for thyroid storm?

A

BB
thionamides
Lugol’s solution
steroids

127
Q

How big does a thyroid nodule have to be to be biopsied with FNA?

A

> 1 cm

Appendix (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions