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Absite Behind the Knife > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Embryologic origin of thyroid?

A

Endodermal cells of foramen cecum

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2
Q

What may persist during descent of thyroid tissue

A

pyramidal lobe

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3
Q

If the thyroglossal duct doesn’t close what can happen

A

Thyroglossal duct cyst

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4
Q

What are the C cells origin?

A

4th pharyngeal pouch

Neural crest tissue

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5
Q

What is the blood supply of the thyroid gland?

A

Superior thyroid

Inferior thyroid

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6
Q

What is the anatomic location of the superior thyroid artery?

A

1st branch of external carotid, runs with superior laryngeal nerve.

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7
Q

What is the anatomic location of the inferior thyroid artery?

A

Branch off thyrocervical trunk, runs with recurrent laryngeal nerve
Provides blood supply to all 4 parathyroid glands
50% of the time passes ant, 50% passes post to recurrent laryngeal

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8
Q

What provides blood supply to all 4 parathyroid glands

A

Inferior thyroid artery

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9
Q

What is the anatomic location of the thyroid IMA?

A

Rises off of inominate

5% of people

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10
Q

Venous drainage of thyroid gland?

A

Superior/Middle Drain into internal jugular

Inferior drains into inominate(bracheocephalic)

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11
Q

Hyperthyroidism tx?

A

1st medical therapy
PTU, Methimazole: Agranulocytosis, aplastic anemia

PTU okay for pregnancy
Methimazole causes cretinism in pregnancy

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12
Q

Graves Disease pathophys?

A

Autoimmune dz caused by Ab to TSH -> hyperthyroid

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13
Q

What does graves look like on scintigraphy?

A

Diffuse uptake of entire thyroid gland

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14
Q

Grave Disease tx?

A

1st medical management
PTU, Methimazole, beta blocker

2nd
Radioactive ablation

3rd - Surgical tx
Thyroidectomy

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15
Q

If grave’s needs thyroidectomy what is important to do pre-op?

A

Must be euthyroid
Beta blocked + Lugol’s solution 14 days prior to surgery
To avoid thyroid storm

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16
Q

Toxic multinodular goiter - pathophys

A

Prolonged low grade TSH stimulation - cause

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17
Q

Toxic multinodular goiter Tx

A

Total or subtotal lobectomy

because iodine ablation doesn’t work as well

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18
Q

Hyper-Thyroid workup

A

1st: TSH
If low then think hyperthyroid
2: US w/ FNA

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19
Q

Hashimoto’s thyroiditis pathophy, s/s, treatment?

A

Chronic lymphocytic thyroiditis
Anti thyroid antibodies
Enlarged painless thyroid
Tx: Tyroid replacement

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20
Q

Dequervian’s (subacute granulomatosis thyroiditis) pathophy, s/s, treatment?

A 
Viral etiology
Painful
Elevated ESR
Dec radioiodine uptake
Tx: Pain control, beta blockers, steroids
21
Q

Palpable thyroid nodule workup

A

5% turn out to be malignant

H/P: Hx of radiation, FHx of thyroid and endocrine cancers

Labs: TSH

Imaging: US - hypoechogenicity, microcalcification, irregular margins, lymphatic invasion

Thyroid scintigraphy: Distinguish btw solitary toxic adenoma and graves disease with cold nodules

FNA Biopsy: Solid hypoechoic nodule > 10 mm

22
Q

Bethesda Criteria

A

6 possibilites, if discordinant with imaging repeat biopsy.

Repeat FNA if non diagnostic, Follicular cells of undetermined significance;

Just due lobectomy if follicular neoplasms;

If suspicious for malignancy do lobectomy w/ frozen section to see if you need to do a total

1: Non diagnostic - repeat FNA
2: Benign - Okay
3: Follicular of undetermined sig - repeat FNA
4: Follicular neoplasm - lobectomy
5: Suspicious of malignancy - lobectomy with frozen
6: Malignant - Total thyroidectomy

23
Q

Papillary CA - MC cancer

A

Hx: irradiation to neck
Epidemiology: Women
s/s: Palpable lymph nodes, rare mets
Local invasion affects prognosis
Path: Orphan annie nuclei -> White circle, cleared out nuclei
Tx: Total thyroidectomy - b/c 3 benefits - Removal of potential multifocal disease, preparation of post op radioiodine therapy, able to use thyroglobulin for surveillance

24
Q

What if with papillary CA identify + nodes, biopsy of nodes shows thyroid tissue, or intraop have + nodes

A

Tx: Total thyroidectomy, expand dissection (include level 6), removal of nodes in section where nodes are posititve

25
Q

Adjuvant therapy?

A

Adjuvant radioactive iodine when TSH elevated ->4-6 weeks post op
Hold exogenous thyroid hormone (levothyroxine - because long half life), or give a recombinant TSH b/c shorter half life post op

26
Q

Follicular thyroid CA

A

Hematogenous spread
Rare lymph spread
Hurthle cells - more aggressive follicular
Tx: Total thyroidectomy after lobectomy for diagnosis, w/ radioactive iodine ablation
Modified radical neck dissection (if positive nodes)

27
Q

Medullary thyroid CA

A

Parafollicular C cells - neural crest origin, 4th pharyngeal pouch
Produces calcitonin - if > 400 then higher likelihood of mets
Radioactive iodine is ineffective
50% secretes CEA
20% germline mutations in RET proto-oncogene (MEN, familial thyroid cancer)
80% sporadic
Tx: Total thyroidectomy w/ central node dissection if - nodes
Total thyroidectomy w/ central and lateral node dissection if + nodes (levels 2-6)
Surveillance: Measure calcitonin and CEA levels q 6 months for 1 year, then annually afterwards

28
Q

Central node dissection

A

level 6

29
Q

Lateral node dissection

A

Levels 2-5

30
Q

Anatomic variation - non recurrent R laryngeal nerve

A

Arteria lucoria: Aberrant R subclavian artery

31
Q

How to avoid injury to superior laryngeal nerve

A

Ligate superior pole vessels close to thyroid

32
Q

Monitor for surveillance

A

Total thyroglobulin

33
Q

Most active thyroid hormone

A

T3

34
Q

Where is T3 most produced?

A

Peripherally with deiodinase

35
Q

Midline mass moves up and down with patient swallowing?

A

Thyroglossal duct cyst- Remanant of foramen cecum

Tx: Resect cyst with mid point of hyoid bone, b/c of small risk of malignant regeneration and risk of infection

36
Q

What causes fever, tachycardia, HTN post op in pt with Graves?

A

Thyroid storm
Did not pre-op with beta blockade, PTU, lugols
Tx: Cooling blankets, beta blockade, PTU, lugols, O2

37
Q

Elevated calcitonin most common symptom?

A

Diarrhea

38
Q

MEN 2A when is prophylactic thyroidectomy

A

6 y.o

39
Q

MEN 2B when is prophylactic thyroidectomy

A

< 2 y.o.

40
Q

Likelihood of thyroid cancer in a kid < 14 w/ thyroid nodule

A

50%

Most commonly papillary cancer

41
Q

Acute suppurative thyroiditis most common organisms

A

Staph aureus

Strep pyogenes

42
Q

Acute suppurative thyroiditis presentation

A

Tender, fluctuant goiter, Inc WBC, normal thyroid function tests, age 20-40 y.o.

43
Q

Acute suppurative thyroiditis diagnosis

A

Imaging - US

FNA -> Gram stain and culture

44
Q

Acute suppurative thyroiditis treatment

A

IV abx

If pyriform sinus fistula or abscess then surgical drainage

45
Q

Non tender asymptomatic thyroid nodule w/o adenopathy workup

A

US
FNA
(scintigraphy not useful, it is useful if the person is hyperthyroid and you want to know if hot or cold nodule)

46
Q

Malignant US findings

A 
Heterogeneous
Hypoechoic
Microcalcifications
Hypervascular
Cervical Adenopathy
47
Q

Treatment for nodule in Men > 60

A

Excision
Risk of cancer goes from 12 -> 70% from age 60->70 in men.
Men at higher risk for nodule being cancer, women at higher risk for having a nodule
Cold nodule more likely to be cancerous.

48
Q

Myxedema coma presentation

A

hypothyroidism; hypocortisolemia; hypoventilation, often requiring intubation; hypothermia; hyponatremia; hypotension; hypoglycemia; and infection. Insulin administration would be inappropriate in the setting of hypoglycemia.

Absite Behind the Knife (11 decks)

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