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Surgery > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Normal tsh

A

0-5 miu/l???

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2
Q

Serum t3

A

1.2-3.1 nmol/l

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3
Q

Serum thyroxine

A

55-150nmol/l

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4
Q

Free t3

A

0.3% 3to 9 pmol/l

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5
Q

Free t4

A

0.03% 8 to 26 pmol/l

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6
Q

Serum creatinine

A

Inc in hyper

De in hypo

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7
Q

Serum cholesterol

A

Inc in hypo

Dec in hyper

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8
Q

Causes of thyrotoxicosis without hyperthyroidism

A 
Ectopic fn thyroid
Struma ovarii
Fn metastaticfollicular ca
Trophoblastic tumour
Thyrotoxicosis factitia
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9
Q

Drugs causing thyrotoxicosis

A

Amiodarone (str similr to t4)

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10
Q

Pecipitatng factors for thyrotoxicosis

A

Puberty preg emotion infection

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11
Q

histological graves disease

A

acinasr cell hypertrophy hyperplasia
absence of normal colloid
tall columnar epithelium

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12
Q

tshr observed in

A

graves disease only

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13
Q

toxic adenoma

A

benign fn monoclonal thyroid tumour>3cm
not tsh resp
no eye signs
t3>t4

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14
Q

rai shud not be used in

A

preg n lactation

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15
Q

thyrotoxicosis factitia

A

intake of l thyroxine without indications or overdose

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16
Q

jod basedow effect

A

hyper in goitre patient after administration of increased doses of iodide or iodine contrast agents or amiodarone

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17
Q

antibodies in graves disease

A

tsi nd lats

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18
Q

essential components of graves disease

A

diffuse goitre thyrotoxicosis autoimmune manifestations like infiltrative ophthalmopathy dermopathy myopathy

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19
Q

treatment of toxic adenoma

A

intially antithyroid drugs asftr 6 weeks hemithyroidectomy

rai?

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20
Q

subclinical hyperthyroidism may present as

A

cardiomyopathy nd arrythmias

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21
Q

neonatal thyrotoxicosis

A

born to mother with graves due to crossing of tsi across placventa
toxic for only 3to4 weeks

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22
Q

unexplained diarrhoea could be an affect of

A

thyrotoxicosis

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23
Q

diff btw primaryb and secondary thyrotoxicosis

A 
symptoms frst
diffuse thrill bruit
more severe
eye signs common
hepatosplenomegaly
younger age
no prexisting goitre
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24
Q

symptoms of thyrotoxicosis

A 
wt loss diarrhoea
palpitations angina ccf
fatigue muscole weakness trmor(?)
increase in linear growth in children
oligo or amenorrhoea
hair loss gynaecomastia pruritus palmar erythmia
irritability nervousness insomnia
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25
Q

what causes lid retraction?

A

sympathetic overactivity

spasm of mullers muscle(lps)

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26
Q

von grafes sign

A

lid lag

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27
Q

dalrymples sign

A

upper eyelid retractionm

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28
Q

stellwags

A

staring sign (retraction nd contraction so widening of palpebral fissure)

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29
Q

joffroys sign

A

no wrinkling

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30
Q

moebius sign

A

lack of convergence
lymphocytic infiltration of inferior oblique and rectus muscle
eventual diplopia nd ophthalmoplegia

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31
Q

naffzigers sign

A

…

32
Q

jellineks

A

pigmentation

33
Q

enroth

A

edema of eyelids nd conjunctiva

34
Q

frst sign to appear

A

stellwags

35
Q

order of appearance of signs

A

stellwags
von grafe
joffroys
moebius

36
Q

exophthalmox due to

A

infiltration of retrobulbar tissues with fluid nd round cells with lid spasm

37
Q

malignant exophthalmos

A

edema chemosis conj injection

diplopia ophthalmegia corneal ulcerations papilloedema loss of vision

38
Q

treatment of severe exophthalmos

A 
emergency``
iv steroid iv antibiotics diuretics
gaunethidine steroid drops antibiotic drops
lateral tarsorrhaphy orbital decompression
dark spectacles protective eye patches
local radiation?
methylcellulose
....
39
Q

exophthalmos nd ophthalmopathy may be worsened by

A

antithyroid drugs

thyroidectomy?

40
Q

criles grading

A

sleeping pulse rate for three consecutive nights nad average
1 <90
90 to 110
>110

41
Q

cardiac manifestations in thyrotoxicosis

A

ectopic pulsus paradoxus wide pp multiple extrasystoles paroxysmal atrial tachycardia
paroxysmal atrial fibrillation af not responding to digoxin

42
Q

which muscles more affected?

A

proximal muscles

isometric contraction

43
Q

pretibial myxoedema

A

hyper
bilateral symmetrical shiny red thickened sklin dry coarse hair feet nd vankles usually
myxomatous deposition like gag nd hyaluronic acid

44
Q

thyroid dermopathy

A

pretibial myXEDEMA pruritus palmar erythema hair thinning dupuytren contracture

45
Q

thyroid acropachy

A

clubbing of fingers and toes in primary thyrotoxicosis

hypertrophic pulmonary osteoarthropathy

46
Q

investigations for thyrotoxicosis

A 
thyroid fn test (esp free t3 nd t4)
radioisotope study(hot?)
iv 99mtc
trh
ecg
total count nd neutrophil(y?)
tsi estimation
47
Q

tbg raised in

A

pregnancy
hyperestrogenism
cirrhosis

48
Q

tbg decreases in

A

high androgen levels
hypopproteinimia
acromegaly

49
Q

discordant nodule

A

warm in tc scan
cold in rai
malignancy?

50
Q

treatment for thyrotoxicosis

A 
bb
ccb
oral rehydration?
lugols iodine 10 drops 3x
methimazole carbimazole propylthiouracil
steroids
rai
thyroidectomy
51
Q

hormone dependent tumour

A

papillary carcinoma of thyroid

52
Q

woolner classification

A

occult primary
intrathyroidal
extrathyroidal

53
Q

variants of pct

A

micropapillary
encapsulated
diffusing sclerosant
papillofollicular?

54
Q

microscopy pct

A

cystic spaces papillary projections
psammoma bodies orphan annie nucleus(not seen in fnac)
tall cell type columnar type

55
Q

pct spread

A

slowly progressive less aggressive
usually no blood spread
..

56
Q

clinical features pct

A

soft /hard/firm solid/cystic solitary/multinodular

lymph nodes

57
Q

diagnosis of pct

A 
fnac thyroid nd nodes
radioisotope-cold
tsh
x ray\us neck
mri
58
Q

treatment of pct

A

total or near thyroidectomy with central node compartment dissection
suppressive dose of l thyroxine
lcnd or mrnd
rait

59
Q

suppressive dose of l thyroxine

A

0.3 mg od life long

60
Q

target level of tsh after surgery

A

<0.1 mU/L

61
Q

side effects of lifelong l thyroxine

A

osteoporosis

62
Q

ames score

A

pct

age40 met ext size4

63
Q

ages score

A

age grade extent size

64
Q

lymph node status does not alter the prognosis of

A

pct

65
Q

thyroid paradox

A

cellular tumourws are soft cytic hard

in pct

66
Q

psammoma bodies are seen in

A

pct
meningioma
serous cystadenoma of ovary

67
Q

fnac is useful in

A

follicular carcinoma

68
Q

thyroglobulin immunostaining is positive in

A

fct

69
Q

typical features in fct

A

capsular invasion and angioinvasion

bone secondaries common in skull-warm vascular soft fluctuant localized non mobile pulsatile nd other flat bones

70
Q

why bone sec in fct is pulsatile

A

outer and inner tables disrupted nd metastasis contains colloid pulsation is transmitted to scalp through fluid colloid

71
Q

investigations fct

A 
frozen section biopsy intial hemithyroidectomy?
us abdomen cxr xray bones ct head body
trucut biopsy(but..?
72
Q

treatment fct

A

total thyroidectomy with central node compartment dissection lvl 6
lcnd or mrnd
post op rai
maintennce dose of l thyroxine .1mg od or t3 80ug /day

73
Q

tsh level to be maintained for tissue uptake of iodine

A

30miu/l

74
Q

Horners syndrome

A

Enophthalmos
Anhydrosis
Ptosis
Meiosis

75
Q

5 cardinal signs of primary toxic goitre

A 
Eye signs
Tremor
Tachycardia
Moist skin
Bruit

Surgery (6 decks)

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