Thyroid

Question 1

Ultrasonography (high risk criterias)

Answer 1

• hypoechoic
• microcalcifications
• irregular borders
• taller than wider

Question 2

FNA if

Answer 2

> 1cm if 
  - previous radiation exposure
  - fam hx of thyroid cancer
  - hoarseness
  - rapid growth
> 1cm with high risk
> 2cm with low risk

Question 3

FNA gives Bethesda

Answer 3

I non diagnostic or unsatisfactory
II benign (3% malignity risk)
III AUS Atypia of undetermined significance (5-15%)
IV Follicular neoplasm (15-30%)
V Suspicion of malignancy (60-75%)
VI Malignant (97-99%)

Question 4

Indication to operate a nodule

Answer 4

III or higher
> 4cm
complex cysts

Relative indication : toxic nodule

Question 5

T4

Answer 5

Thyroxin

Question 6

T3

Answer 6

Triiodothyronine

Question 7

TSH

Answer 7

Thyroid Stimulating Hormone

or Thyrotropin

Question 8

Thyroglobuline (TG)

Answer 8

Precursor of T4 and T3

Question 9

Iod scintigraphy useful for

Answer 9

Hyperthyroid situation
do differentiate between:
- diffuse Hyperthyroidism (M.Basedow)
- localized hyperfunction (autonome or toxic nodule)

Question 10

Autonomous nodule

Answer 10

TSH is suppressed

T4 normal

Question 11

Toxic Adenoma

Answer 11

Clinically manifest hypertoxicosis

Question 12

Indication to operate a Struma

Answer 12

Multinodose

Benign with compression (Trachea, Esophagus)

Question 13

If Hyperthyreotic before operation

Answer 13

Bring to euthyreosis

Question 14

Screening for Hashimoto

Answer 14

antimicrosomal and antithyreoglobulin antibody

Question 15

Hasimoto on US

Answer 15

Diffuse heterogenous hypoechogenicity

Question 16

Post partum Thyroiditis

Answer 16

Serial thyroid function test to evaluate progression
TTT: BBlocker
Antithyroid and radio-iodine therapy does not work.
2-8 weeks after delivery

Question 17

Structures to spare during the operation

Answer 17

recurrent laryngeal nerve

parathyroid

Question 18

Operation types

Answer 18

Enucleation
Pole resection
Hemithyroidectomy

Question 19

Dunhill Operation

Answer 19

for M. Basedow
Hemithyroidectomy on one side
Subtotal on other side
leave 6ml volume of thyroid stays
50% post operative euthyreosis

Question 20

Operation for carcinoma

Answer 20

Total thyreoidectomy
Hemithyreoidectomy only for law risk:
- monocentric papillary carcinoma
- small >15mm and young patients

Question 21

Centrocervical neck dissection for

Answer 21

bilateral carcinoma

medullary carcinoma

Question 22

Back Door approach

Answer 22

between Sterno hyoid and SCM