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Thyroid > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Pharyngeal pouches

A

1st and 2nd

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2
Q

Superior thyroid artery

A

1st branch of external carotid artery; gives off superior laryngeal artery

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3
Q

Inferior thyroid artery

A

off thyrocervical trunk off subclavian; supplies sup & inf parathyroids; RLN usually adjacent to inferior thyroid a

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4
Q

Superior & middle thyroid veins

A

drain into internal jugular vein

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5
Q

Inferior thyroid vein

A

drains into innominate & brachiocephalic veins

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6
Q

Recurrent laryngeal nerve

A

motor to all of larynx except cricothyroid muscle; run in tracheoesophageal groove

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7
Q

Left RLN

A

loops around aorta

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8
Q

Right RLN

A

loops around right subclavian or innominate artery

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9
Q

RLN injury

A

hoarseness; b/l injury can obstruct airway

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10
Q

Superior laryngeal nerve

A

motor to cricothyroid muscle; runs lateral to thyroid lobes

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11
Q

Superior laryngeal nerve injury

A

loss of projection and easy voice fatigability (opera singers)

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12
Q

Tubercles of Zuckerkandl

A

most lateral, posterior extension of thyroid tissue rotate medially to find RLNs; this portion is left behind with subtotal thyroidectomy because of proximity to RLNs

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13
Q

Ligament of Berry

A

posterior medial suspensory ligament; primary point of fixation of thyroid to surrounding structures; close to RLNs

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14
Q

Thyrotropin-releasing factor

A

released from hypothalamus; acts on anterior pituitary gland & causes release of TSH; release is controlled by T3 and T4 through negative feedback loop

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15
Q

Thyroid stimulating hormone

A

release from anterior pituitary gland; acts on thyroid to release T3 and T4 through mechanism that involves increase cAMP; release is controlled by T3 and T4 through negative feedback loop; most sensitive indicator of gland function

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16
Q

Thyroglobulin

A

stores T3 and T4 in colloid

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17
Q

Plasma T4:T3 ratio

A

15:1; T3 more active form (tyrosine + iodine); most T3 produced in periphery by T4 to T3 conversion by peroxidases (link or separate tyrosine & iodine)

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18
Q

Thyroid-binding globulin

A

thyroid hormone transport; T3 & T4 also bind albumin

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19
Q

Parafollicular C cells

A

produce calcitonin (inhibit calcium absorption by osteoclasts; decrease peripheral serum Ca levels)

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20
Q

Thyroxine treatment

A

TSH levels should fall to 50%; osteoporosis long term side effect

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21
Q

Thyroid storm

A

tachy, fever, numbness, v/d, hight output cardiac failure (MCC of death); most common after surgery in pt with undx Graves’ disease

22
Q

Thyroid storm tx

A

B-blockers, PTU, Lugol’s solution, cooling blankets, O2, glucose, fluid

23
Q

Wolff-Chaikoff Effect

A

very effective for pts in thyroid storm; give high doses of iodine (Lugol’s solution, KI) which inhibits TSH action on thyroid & inhibits organic coupling of iodide; results in less T3 & T4 release

24
Q

Asymptomatic Thyroid Nodule

A

85% are benign; F>M

1st thyroid function tests: if elevated give thyroxine; nodule should regress in 6 months; if not elevated FNA

25
Q

FNA thyroid nodule

A

determinant in 75-90%
follicular cells: total or lobectomy (5-10% malignancy)
thyroid ca: total or lobectomy
cyst fluid: drain; if recurs then surgery
colloid tissue: likely goiter; low chance of malignancy (

26
Q

Radionuclide study

A

hot nodule: thyroxine for 6 months, if size does not decrease then surgery
cold nodule: total or lobectomy (more likely malignant than hot)

27
Q

Goiter

A

any abnormal enlargement; most common cause is iodine deficiency; tx with iodine replacement

28
Q

Nontoxic colloid goiter

A

diffuse enlargement w/o evidence of functional abnormality; tx: try to suppress with thyroxine; Iodine-131 (may be ineffective); subtotal thyroidectomy or lobectomy if medical tx fails

29
Q

Substernal goiter

A

usually secondary → vessels originate from superior and inferior thyroid arteries
primary → rare; vessels originate from innominate artery; tx: try to suppress with thyroxine; Iodine-131 (may be ineffective); subtotal thyroidectomy or lobectomy if medical tx fails

30
Q

Mediastinal thyroid tissue

A

most likely from acquired disease with inferior extensions of normally placed gland

31
Q

Lingual thyroid

A

thyroid tissue that persists in area of foramen cecum at base of tongue
Sxs: dysphagia, dyspnea, dysphonia
2% malignancy risk
Tx: thyroxine suppression; abolish with Iodine-131 or resection if it is enlarged or suggestive of cancer, or if it does not shrink after medical tx

32
Q

Thyroglossal duct cyst

A

classically moves upward with swallowing
susceptible to infection & may be premalignant
tx: resection; need to take midportion or all of hyoid bone along with thyroglossal duct cyst (Sistrunk procedure)

33
Q

Graves’ disease

A

MCC of hyperthyroidism (80%); caused by IgG antibodies to TSH receptor; decrease TSH, increase T3 & T4; tx with thioamides (70% recurrence), RAI (10% recurrence), subtotal thyroide (10% recurrence) or total thyroid with thyroxine replacement if medical tx fails

34
Q

Graves’ disease and surgery

A

medical therapy usually manages hyperthyroidism; unusual have to operate on these patients unless in setting of suspicious nodule
Pre op prep → PTU or methimazole until euthyroid, β-blocker 1 week before surgery, Lugol’s solution for 10-15 days to decrease friability & vascularity (start only after euthyroid)

35
Q

Indications for surgery in Graves’ disease

A

noncompliant pt, recurrence after medical therapy, children, pregnant women not controlled with medical therapy, or concomitant suspicious thyroid nodule

36
Q

Toxic Multinodular Goiter

A

MCC of thyroid enlargement; women; age > 50, normal thyroid fx tests; cardiac symptoms, weight loss, insomnia, airway compromise; symptoms can be precipitated by contrast dyes; caused by hyperplasia 2/2 chronic low-grade TSH stimulation
Tx: RAI & thioamides; subtotal thyroidectomy if medical tx ineffective; unusual have to operate on these pts unless in setting of suspicious nodule

37
Q

Hashimoto’s disease

A

MCC of hypothyroidism in adults; enlarged gland, painless, chronic thyroiditis; women; hx of childhood xRT; can cause thyrotoxicosis in acute early stage; caused by both humeral & cell-mediated autoimmune disease (microsomal & thyroglobulin antibodies); goiter 2/2 lack of organification of trapped iodide inside gland; path shows a lymphocytic infiltrate; Tx: thyroxine 1st line; partial thyroidectomy if continues to grow despite thyroxine, if nodules appear or compression symptoms occur; frequently no surgery is necessary for Hashimoto’s disease

38
Q

Bacterial Thyroiditis

A

usually 2/2 contiguous spread; normal thyroid function tests, fever, dysphagia, tenderness; upper respiratory tract infection (URI) symptoms most common precursor (staph/strep); Tx: antibiotics; may need lobectomy to r/o cancer in pts with unilateral swelling & tenderness; may need total thyroidectomy for persistent inflammation

39
Q

De Quervain’s Thyroiditis

A

can be associated with hyperthyroidism initially; viral URI, tender thyroid, sore throat, mass, weakness, fatigue; more common in women; elevated ESR; Tx: steroids & ASA; may need lobectomy to r/o cancer in pts with unilateral swelling & tenderness; may need total thyroidectomy for persistent inflammation

40
Q

Riedel’s Fibrous Struma (rare)

A

woody, fibrous component that can involve adjacent strap muscles & carotid sheath; can resemble thyroid CA or lymphoma (need biopsy); disease frequently results in hypothyroidism & compression symptoms; associated with sclerosing cholangitis, fibrotic diseases, methysergide treatment, and retroperitoneal fibrosis; Tx: steroids & thyroxine; may need isthmectomy or tracheostomy; if resection needed, watch for RLNs

41
Q

Follicular adenomas

A

colloid, embryonal, fetal; no increase in cancer risk; still need lobectomy to prove its adenoma

42
Q

Papillary thyroid carcinoma

A

most common (80-90%) thyroid ca; least aggressive, slow growing, has best prognosis; young adults, women, children; childhood XRT; lung mets most common; Path psammoma bodies (calcium) & orphan annie nuclei; lymphatic spread 1st but is not prognostic

43
Q

Papillary thyroid ca TX

A

minimal / incidental ( 1cm; clinically + cervical nodes → need ipsilateral MRND; extrathyroidal tissue involvement → need ipsilateral MRND;
metastatic disease, residual local disease, + lymph nodes, or capsular invasion → RAI 6 weeks post op;
XRT only for unresectable disease not responsive to RAI

44
Q

Enlarged lateral neck LN that shows normal thyroid tissue

A

papillary thyroid CA with lymphatic spread; tx with total thyroid & MRND

45
Q

Follicular Thyroid Carcinoma

A

hematogenous spread → bone most common; 50% have metastatic disease at time of presentation; more aggressive than papillary; older adults 50-60s, women; FNA shows just follicular cells → 10% chance of malignancy; need thyroidectomy

46
Q

Follicular Thyroid Ca TX

A

lobectomy → if pathology shows adenoma or follicular cell hyperplasia, nothing else needed;
if follicular CA → total thyroidectomy for lesion > 1cm or extrathyroidal disease;
clinically positive cervical nodes → need ipsilateral MRND;
extrathyroidal tissue involvement → need ipsilateral MRND;
pts with lesion > 1cm or extrathyroidal disease or capsular invasion → RAI 6 weeks post op;
if microinvasive (

47
Q

Medullary Thyroid Carcinoma

A

can be assoc with MEN IIa or IIb (RET protooncogene);
usually 1st manifestation of MEN IIa and IIb → screen for hyperparathyroidism & pheochromocytoma;
tumor arises from parafollicular C cells (which secrete calcitonin);
C-cell hyperplasia considered premalignant; Pathology → shows amyloid deposition;
Gastrin can be used to test for medullary thyroid CA → causes increase in calcitonin;
elevated calcitonin can cause flushing and diarrhea;
most have involved nodes at time of dx;
early mets → lung, liver, bone

48
Q

Medullary Thyroid Carcinoma TX

A

total thyroidectomy with central neck node dissection;
MRND if pt has clinically + nodes (b/l MRND if both lobes have tumor) or if extrathyroidal disease present;
prophylactic thyroidectomy in MEN IIa or IIb patients before 5 yo;
liver & bone mets prevent attempt at cure;
XRT may be useful for unresectable local & distant metastatic disease;
may be useful to monitor calcitonin levels for disease recurrence;
more aggressive than follicular & papillary CA;
50% 5 year survival rate; prognosis based on presence of regional & distant mets

49
Q

Hurthle cell carcinoma

A

most are benign (adenoma); presents in older pts; early nodal spread if malignant; mets go to bone and lung; Tx: total thyroidectomy; MRND for clinically + nodes

50
Q

Anaplastic Thyroid Cancer

A

elderly patients with long-standing goiters; most aggressive thyroid ca; rapidly lethal (0% 5 year survival rate); usually beyond surgical management by dx; Tx: total thyroidectomy for compressive symptoms or give palliative chemo or XRT

Thyroid (1 decks)

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