Thyroid

Question 1

The Superior thyroid artery is the first branch of the __________?

Answer 1

external carotid artery

Question 2

Origin of inferior thyroid artery

Answer 2

thyrocervical trunk

Question 3

what is the ima artery origin and destination

Answer 3

origin: innominate
destination: isthmus

Question 4

what does the superior laryngeal nerve innervate?

what happens with injury to this nerve?

Answer 4

1. cricothyroid muscle

2. loss of projection and voice fatigue

Question 5

path of right recurrent laryngeal nerve?

Answer 5

follows vagus and loops around right subclavian artery

Question 6

path of left recurrent laryngeal nerve

Answer 6

loops around aorta

Question 7

is T3 or T4 more plentiful in the periphery?

Answer 7

T4

Question 8

is T3 or T4 more active?

Answer 8

T3

Question 9

does the thyroid make more T3 or T4?

Answer 9

80% T4, 20% T3

Question 10

embryologic origin of the thyroid

Answer 10

4th endodermal POUCH

Question 11

what is the treatment for thyroid storm?

Answer 11

beta blockade and lugol’s solution, cooling blankets.

pre-op lugols can prevent thyroid storm

Question 12

what is the workup of thyroid nodule?

Answer 12

ultrasound and FNA

Question 13

concerning features of thyroid nodule on US?

Answer 13

hypoechoic, micro-calcification, irregular margins, unorganized vasculature, lymphatic invasion

Question 14

what are the stages of Bethesda criteria and treatment?

Answer 14

1. indeterminate - repeat FNA
2. Benign - repeat US in 6-12 mos
3. AUS/FLUS - repeat FNA
4. follicular neoplasm - lobectomy
5. suspicious for malignancy - lobectomy
6. malignancy - total thyroidectomy

Question 15

Tx of hyperthyroidism

Answer 15

PTU or MMI

Question 16

PTU side effects?

Answer 16

aplastic anemia, agranulocytosis

Question 17

MMI side effects?

Answer 17

cretinism, aplastic anemia, agranulocytosis

Question 18

is PTU or MMI safe during pregnancy?

Answer 18

PTU - does not cross placenta

Question 19

pathophysiology of graves disease?

Answer 19

antibodies against TSH receptors

Question 20

treatment of multi-nodular goiter?

Answer 20

total or subtotal thyroidectomy

Question 21

pathophys of Hasimoto’s thyroiditis?

Tx?

Answer 21

antithyroid antibodies

Tx with hormone replacement

Question 22

cause of subacute granulomatous thyroiditis?

treatment?

Answer 22

viral cause

treat with NSAIDs

Question 23

Most common thyroid malignancy

Answer 23

papillary thyroid carcinoma

Question 24

histology of PTC?

Answer 24

orphan annie nucleus, psammoma bodies, nuclear inclusions

Question 25

treatment of PTC?

Answer 25

total thyroidectomy +/- level VI dissection

–can follow thyroglobulin for surveillance, postop radioiodine tx, removal of multifocal disease

Question 26

tx for follicular thyroid cancer?

Answer 26

lobectomy +/- MRND for + nodes, post op RAI - FNA unreliable in many cases

Question 27

follicular thyroid cancer - hematogenous or lymphatic spread?

Answer 27

hematogenous

Question 28

PTC - hematogenous or lymphatic spread?

Answer 28

lymphatic

Question 29

what cells cause medullary thyroid cancer ?

Answer 29

parafollicular C cells

Question 30

gene associated with medullary thyroid cancer

Answer 30

RET proto-oncogene

Question 31

Tx of medullary thyroid cancer?

Answer 31

total thyroidectomy with central neck dissection - MRND if + LNs

Question 32

surveillance for medullary thyroid cancer?

Answer 32

CEA and calcitonin. calcitonin takes ~ 8wks to come down

Question 33

when should patients with MEN2A and MEN2B get total thyroidectomy?

Answer 33

by 5 years of age typically