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RCSI SURGERY > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Arterial supply to thyroid

A

inferior and superior thyroid arteries

thyroidia ima artery may be present

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2
Q

Veins to the thyroid

A

Superior Inferior Middle thyroid veins

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3
Q

Lymph drainage of thyroid

A

Pre tracheal, lrelaryngeal and paratracheal nodes

eventually drain into the thoracic duct

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4
Q

nerves by the thyroid

A

external laryngeal nerve - passes MEDIALLY to the superior portion of the thyroid glad to innervate cricothyroid

Recurrent laryngeal nerve- lies in groove b/w trachea and oesophagus and emerging medially to the inferior part of the thyroid

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5
Q

what are the names of acute, subacute and chronic thyroiditis

A

Acute - acute inflammation of the thyroid glad

Sub-acute - De QUervians

Chronic - Redials

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6
Q

why does MAiodarone cause hyper and hypo thryoidism

A

due the inhibition of monodeiodination of T4 (which reduces T3) , the blocking of T3 receptors and a direct toxic effect leading to follicular destruction

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7
Q

iodine deficiency 0 what will thyroid be like

A

multi nodular cyst

thyroidglossal fistula

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8
Q

ddx for midline neck swelling

A

thyroid isthmus

thyroidgloassal duct cyst

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9
Q

Anterior triangle Ddx

A
  1. Thyroid (MNG, solid - B or M , physiological, iodine deficiency, pregnany , puberty , inflammatory, A.I)
  2. Brachial cleft cyst
  3. Carotid body tumour (chemodectoma) - pulsate but not expansile, moves laterally and not up and down
    - paraganglioma
    - neuroblastoma
  4. lipoma
  5. subcutaneous cyst
  6. sarcoma
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10
Q

posterior triangle of the neck

A
  1. skin
  2. lymph node
  3. bone
  4. cystic hygroma - multilobulated lymphangioma (congenital on left)
  5. parotid swelling 0 Warthrin’s tumour - adenolymphoma, benign - ass. w/ smoking
  6. Zener’s diverticulum AKA pharyngeal pouch
  7. SCM tumour - children , may cause torticolitis
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11
Q

inflammatory neck lumps

A
  1. Post viral LAD - >1cm, usually resolves >2 week
  2. bacterial - mycobacteria, acintomycin, brucellosis, cat scratch disease
  3. HIV
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12
Q

malignant neck swelling

A

metastatic - lung ,esophagus, breast

thyroid

Salivary glad

Lymphoma

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13
Q

causes of thyroidtoxicosis

A
  1. Graves
  2. TMN
  3. Solitary toxic nodule
  4. thyroiditis (hashimoto’s , de quervain’s, post part)
  5. drugs - amiodarone
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14
Q

RF of thyroidtoxicois

A
  1. A. fib
  2. osteoporosis
  3. thyroid storm
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15
Q

define graves

A

autoimmune syndrome consisting of hyperthyroidism, goitre and pretibial/ localizing myxoedema. It is disease characterized by the presence of TSH receptor antibodies and most commonly occurs in women in their 3rd and 4th decade of life

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16
Q

when do you use PTU for Graves

A

only in ppl who can’t tolerate carbimazole being lowered

use for 18 months

17
Q

side effect of radio-iodine

A
  1. hypothyroidism
  2. thyroiditis
  3. transit worsening of graves opthalmopathy
18
Q

Hartley Dunhill procedure

A

when you removed entire lobe on one side, and only subtotal thyroidectomy on the other side - MOST COMMON SURGERY

19
Q

Graves opthalmopathy - what type of surgery

A

total thyroidectomy

20
Q

when can you consider doing thyroid surgery

A

patient MUST be euthyroid prior to surgery - to decrease vascularity of gland

21
Q

Papillary RF, Pathological findings , mets and prognostic factors

A

RF - Radiotherapy, Fam History
Path : Orphan Annie Nuceli , psammoma bodies, nuclear groove
Mets: 2-10% , 2/3 - lung, 3/4 - skeletal system, rare - brain liver kidneys and adrenal
Prognostic
Good: age - young, Small size
Bad: mets, soft tissue Invasion

22
Q

Follicular RF, Pathological findings , spread and mets

A

Rf: Family history, radiotherapy, iodine
path: capsulated , colloid present , hurtle cells
HEMATOGENOUS SPREAD
skeletal system and lungs
Rare: brain liver, bladder , skin
Mets = Hormonally active - HYPERTHYROIDism

23
Q

MEDULLARY definition , path, inherited

A

neuroendocrine tumour of parafollicular or C cells of the thyroid
Normal function test
increase calcitonin level - deposits as amyloid (flushing, diarrhea)
Inheritance:
1. sporadic - single nodule and often cervical LAD
2. Familial - Men 2 a, Men 2b

24
Q

anaplastic

A

undifferentiated tumours of thyroid follicle epithelium in older women, agree , palliative chemo and radio for symptoms

25
Q

types of thyroid lymphoma

A
  1. diffuse B cell NHL
  2. maltoma
  3. hashimoto’s thyroiditis
26
Q

when do you remove cervical nodes in thyroid cancer

A
  1. when they have a palpable node

2. papillary carcinoma

27
Q

Early complications of thyroidectomy

A
  1. Strap hematoma, transient hypoparathyroidism (8%), hypocalemia, side effect of anaesthesia, serum, larygenal nerve injury, vocal cord paresis

H3 VANS

28
Q

late complications of thyroidectomy

A

permanent hypoparathyroidism

RCSI SURGERY (7 decks)

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