Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GenSurg: Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

Goitre, Solitary Nodules, Neoplasms and Thyrotoxicosis

1
Q

Give the two ways that a thyroid can be enlarged

A

Symmetrically enlarged (goitre) or assymetrically enlarged (solitary nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give a differential diagnosis for neck swellings/masses

A

Thyroid enlargement
Lymphadenopathy
Thyroglossal duct cyst
Salivary gland enlargement
Branchial arch anomal
Cystic hygroma
Pharyngeal pouch
Carotid body tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name the 4 main causes of a goitre (symmetrical thyroid enlargement)

A

Physiological
Simple/non-nodular
Multinodular
Thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a physiological goitre?

A

This is when the thyroid is enlarged due to a normal physiological process. It occurs often during puberty, pregnancy and lactation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical findings in a physiological goitre?

A

The gland is soft, diffusely enlarge, visible and palpable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management of a physiological goitre?

A

Reassurance. No medication is needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a simple/non-nodular goitre?

A

This occurs in areas where iodine is in low concentrations in water or salt is not iodinated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of a goitre?

A

Multinodular goitre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a multinodular goitre?

A

The thyroid gland is enlarged due to multiple adenomatous and colloid nodules with occasional cystic degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pathophysiology of a multinodular goitre?

A

Enlargement is due to longstanding stimulation of the thyroid by TSH during periods of suboptimal thyroid hormone production. Initially, there is diffuse enlargement and the gland goes through cyclical changes of hyperplasia and colloid formation to eventual multinodularity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name 4 drugs that are goitrogens (could cause a goitre)

A

Anti-thyroid drugs
Sulphonylureas
Iodine-containing medication
Cobalt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is thyroiditis?

A

Inflammation of the thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical findings in thyroiditis?

A

Diffuse thyromegaly which may be firm or multinodular.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common thyroiditis?

A

Autoimmune Hashimoto’s thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does de Quervain’s thyroiditis present?

A

Pain and tenderness as well as fever, sore throat and dysphagia along with the other features of thyroiditis - thyromegaly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What investigations are done to confirm thyroiditis?

A

Antibody serology
Aspiration cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for thyroiditis?

A

Steroids and aspirin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are causes of a solitary thyroid nodule?

A

Hyperplastic/adenomatous nodule (most common
Simple cyst
Follicular adenoma
Thyroid carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What investigations are done for nodular thyromegaly?

A

Ultrasound
Aspiration cytology
Radio-isotope scanning
CT scans
Blood tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the imaging modality of choice for the thyroid?

A

Ultrasound. It can confirm a nodule vs multinodular thyroid, whether it is solid or cystic and other features associated with malignancy

21
Q

What features of malignancy may be seen on ultrasound?

A

Hypoechogenicity
Increased vascularity
Local lymphadenopathy
Microcalcifications

22
Q

Which classification system is used for thyroid cytopathology?

A

Bethesda
Note - a score of 3 or more warrants concern

23
Q

When is radio-isotope scanning done?

A

Usually only for thyrotoxic patients

24
Q

How are radio-isotope scans interpreted? (Hot vs cold spots)

A

Solid nodules are “cold” while hyperfunctioning nodules are “hot” and almost always benign. The cold nodules require further investigation.

25
Q

What are CT scans helpful for in thyroid disease?

A

Evaluation of retrosternal goitre extension and airway compression

26
Q

Which blood tests should be ordered in thyroid disease investigations?

A

TSH
T4/T3
Serum thyroid antibodies

27
Q

What are the indications for surgery for a solitary thyroid nodule?

A

Suspicious nodule on USS
Cytology which shows malignancy, is suspicious or indeterminate
A cyst that refills after aspiration

28
Q

What are the options for surgery for a solitary nodule? (Partial vs total thyroidectomy etc.)

A

A lobectomy of the affected side is first performed. If it is benign, nothing further is done. However, in general, if it is malignant a total thyroidectomy is done.

29
Q

Which thyroid cancer does not need a total thyroidectomy?

A

<1 cm unifcoal papillary carcinoma. This can be treated with a lobectomy as it is usually well localized.

30
Q

What are the indications for surgery for a multinodular goitre?

A

Most cases of MNG are benign and reassurance is all that is needed. However, indications include:
Compression symptoms - dysphagia, respiratory difficulty, retrosternal extension, or superior mediastinal syndrome)
If it is very unsightly
Any concern of malignancy

31
Q

What are the options for surgery for a MNG? (Partial vs total thyroidectomy etc.)

A

Total thyroidectomy with careful preservation of the parathyroid glands. If the MNG is unilateral, a lobectomy can be performed.

32
Q

Name 7 features suggestive of a malignant thyroid mass

A

Asymmetrical goitre or nodule in children or men
Rapid onset
Progressive size increase
Local invasion
Pain
Lymphadenopathy
Hoarseness

33
Q

What is the most common type of thyroid carcinoma?

A

Well differentiated thyroid carcinomas (WDTCs)

34
Q

Other than WDTCs, what thyroid carcinomas may occur?

A

In decreasing order of prevalence:
Medullary
Anaplastic
Lymphoma
Other rarer types

35
Q

What is the management of WDTC?

A

Surgical - total thyroidectomy
Complementary radioactive iodine - to ablate any residual disease
Endocrine therapy - thyroxin to suppress TSH and thus recurrence of disease

36
Q

What are the histological subtypes of WDTC? Outline common features of each.

A

Papillary (40%) - usually small, multifocal and LN spread common
Follicular (30%) - larger, single nodule with haematogeneous spread, iodine sensitive
Mixed (30%)

37
Q

Which cells are thought to be the precursors for medullary thyroid carcinoma?

A

Calcitonin producing C cells

38
Q

Which syndrome is medullary carcinoma a part of?

A

MEN 2

39
Q

What is the management of medullary carcinoma?

A

It is much more aggressive so a total thyroidectomy is indicated along with nodal dissection. This does not respond to iodine therapy

40
Q

What is anaplastic thyroid carcinoma?

A

Also called undifferentiated thyroid carcinoma. It is the least common and is usually irresectable and incurable at presentation.

41
Q

What is the most common cause of thyrotoxicosis?

A

Graves disease

42
Q

What is the pathophysiology of Graves disease?

A

Auto-immune response to TSH receptors. Antibodies to the receptor cause prolonged stimulation of the receptor and excessive thyroxin production.

43
Q

Other than Graves disease, what are other causes of thyrotoxicosis?

A

Toxic multinodular goitre
Toxic solitary nodule
Excess TSH (pituitary, paraneoplastic)
Excess T4 (iatrogenic, paraneoplastic)
Excess Iodine
Thyroiditis
Struma ovarii

44
Q

How is thyrotoxicosis diagnosed?

A

Clinical features and biochemical confirmation (Low TSH with high T4/T3)

45
Q

What is the management of thyrotoxicosis?

A

The primary treatment is medical. Surgery is only performed when specially indicated.

46
Q

What medicatios are prescribed for thyrotoxicosis?

A

Neomercazole
Propanolol
Radioactive iodine

47
Q

What are the indications for surgery in thyrotoxicosis?

A

Pregnancy
After medical treatment fails
If radioactive iodine is contraindicated
Large, multinodular gland

48
Q

List complications of thyroidectomies

A

Recurrent laryngeal nerve damage
Serious airway obstruction - oedema or haematoma
Haemorrhage
Tracheomalacia
Hypocalcaemia
Hypothyroidism

GenSurg: Endocrine (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions