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USP01Y2 > Thyroid gland > Flashcards

Thyroid gland Flashcards

1
Q

Function of the thyroid gland

A
  • Maintains body metabolism
  • Maintains growth
  • Maintains development
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2
Q

Why are ultrsound the most sensitive modality to evaluate the thyroid gland

A
  • It can detect thyroid lesions
  • it can accurately calculate the dimensions of the thyroid gland
  • It can identify the structures and vascularity
  • It evaluates diffuse changes to the thyroid parenchyma
  • Helps to differentiate between thyroid nodules, and cervical masses
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3
Q

Where is the thyroid located

A

Anteroinferior at the level of the thyroid cartilage

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4
Q

How many lobes in the thyroid

A

Two

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5
Q

What connects the two lobes of the thyroid

A

Isthmus

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6
Q

What are the anterior muscles at the thyroid

A

Strap muscles and sternocleidomastoid muscle

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7
Q

What are the three strap muscles

A
  1. Sternohyoid muscle
  2. Omohyoid muscle
  3. Sternothyroid muscle
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8
Q

What are the posterior structures of the thyroid and neck

A
  1. CCA
  2. JV
  3. Vagus nerve
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9
Q

What is the normal length of the thyroid in an adult

A

4 - 6 cm

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10
Q

What is the normal height of the thyroid gland in adult

A

1.3 - 1.8 cm

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11
Q

What is the normal width of thyroid gland in adult

A

1.5 - 2.0 cm

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12
Q

What is the normal length of the thyroid in children

A

2 -3 cm

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13
Q

What is the normal height of thyroid gland in children

A

0.2 -1.2 cm

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14
Q

What is the normal width of the thyroid gland in children

A

1.0 - 1.5 cm

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15
Q

What is the length, height and widht measurement of the parathyroid in an adult

A

5-7 mm
1-2 mm
3-4 mm

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16
Q

What are the three hormones released by thyroid

A
  1. Triidothyronine (T3)
  2. Thyroxine (T4)
  3. Calcitonin
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17
Q

The pathway of the hormones

A
  1. Hypothalamus releases thyrotropin releasing hormone
  2. TRH triggers pituitary gland to release thyroid stimulating hormone
  3. TSH Stimulates the thyroid to release T3 and T4
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18
Q

What gland secretes parathyroid hormone

A

Parathyroid gland

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19
Q

What is the function of the parathyroid hormone

A

Maintains homeostasis of blood calcium concentration by promoting calcium absorption into the blood preventing hypoglycemia.

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20
Q

Why a thyroid ultrasound

A

When there is a palpable thyroid nodules or multinodular goiter
Patient that are of high risk for thyroid malignancy due to radiation exposure and who are in their reproductive years.
In women between ages of 40-44 and in men between ages of 70- 74. Patients with palpable cervical adenopathy suspicious of malignancy

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21
Q

What should you look for in a thyroid ultrasound

A

If the mass is palpable
If the mass is within o4 adjacent to the thyroid
If the tumor is confined to the thyroid
Is the cervical lymphnodes involved
After operation is there residual or recurrent tumor in the thyroid bed or is there metastases to the lymphnodes in the neck.

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22
Q

What is the normal appearance of the thyroid on ultrasound

A

Uniformly

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23
Q

What are variants of the thyroid gland

A

Pyramidal lobe
Absence of isthmus
Assemetry
Absence of lateral lobes

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24
Q

The three composition of the nodule is

A

Solid
Cystic
Complex

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25
Q

What is the echogenisty of the nodule

A

Hyperechoic
Hypoechoic
Isoechoic
Markedly hypoechoic

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26
Q

How does the margins of the nodule appear

A

Well defined and regular
Ill defined, blurred, irregular

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27
Q

What is the measurement of the nodule

A

Is it taller than wide

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28
Q

Malignant thyroid nodules

A
  • Hyoechoic
  • Micro or interrupted rim calcification
  • Irregular margins
  • Absence of halo or incomplete halo
  • Increased intranodular flow
  • Height is greater than width
  • Significant increase in size over time
  • Invasion of anterior strap muscles
  • Presence of abnormal cervical lymphadenopath.
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29
Q

Benign thyroid lesions

A
  • Pure cystic nodule
  • Hyperechoic
  • Halo sign or smooth margin
  • Spongiform nodule
  • Uninterrupted eggshell calcifications
  • Absent or peripheral vascularity.
  • Significant decrease in size over time
  • Multiple coalescent modules without normal intervening parenchyma
  • Normal small reactive cervical nodes
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30
Q

What is a goiter

A

It’s the enlargement of the thyroid gland due to any cause

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31
Q

What are the two types of goiters

A

Toxic goiter
Non toxic goiter

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32
Q

What is a toxic goiter

A

A hyperthyroid condition resulting from hyperactivity of the thyroid gland

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33
Q

What is a non toxic goiter

A

Diffuse thyroid enlargement not resulting of inflammation, neoplasm, hypo- or hyperthyroidism.
The thyroid is enlarged but the thyroid levels are normal.

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34
Q

What are the sonographic findings of a goiter

A
  • Isochoic compared to normal thyroid tissue
  • As it enlarges it becomes more isoechoic
  • A well defined halo surrounding nodules
  • There is colloid component of cystic elements
  • Focal scarring and ischemia, necrosis and cyst formation
  • Fibrosis or calcifications
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35
Q

What is hyperplasia

A

The enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells.

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36
Q

Thyroid hyperplasia

A

Caused by an iodine deficiency.
Results from anything that lessons the intrthyroidal iodine levels

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37
Q

The sonographic finding of a cyst in thyroid

A

Purely anechoic areas containg serous or colloid fluid

38
Q

What is an adenoma in thyroid

A

A benign thyroid neoplasm that is characterized by complete fibrous encapsulation

39
Q

What are the sonographic features of a thyroid adenoma

A
  • Peripheral halo that appears anechoic to completely hyperechoic
  • Predominantly cystic or mixed cystic and solid lesions
  • Isoechoic or predominantly anechoic
  • Homogenous or heterogenous
  • Increased peripheral blood flow patterns on colour doppler or within
40
Q

What suggest malignancy in the thyroid

A

A solitary nodule with cervical adenopathy at the same side

41
Q

What is the most common malignancy of the thyroid

A

Papillary carcinoma

42
Q

What are the risk factors of papillary carcinoma

A

Females
History of exposure to radiation in childhood
Family history
Obesity

43
Q

What are the sonographic appearance of papillary carcinoma

A
  • Hypoechoic lesion
  • Irregular outline
  • Microcalcifications ( small punctate hyperechoic foci)
  • Hypervascularity
  • Cervical lymphonode metastases
44
Q

Follicular carcinoma

A

Second most frequent malignancy of the thyroid

45
Q

What is the stage of invasiveness of an encapsulated follicular carcinoma

A

Minimally invasive

46
Q

What is the stage of invasiveness of a non capsulated follicular carcinoma

A

Widely invasive as there can be invasion of the blood vessels

47
Q

What organs does follicular carcinoma metastasis to

A

Bone
Brain
Lung
Liver

48
Q

What are the risk factors of follicular carcinoma

A

Females between ages of (40-60)
Radiation exposure
Iodine deficiency
Pre existing thyroid disease

49
Q

What are the sonographic findings of follicular carcinoma

A

Hypoechoic
Irregular margins with thick irregular halo
Nodular enlargement
Tortuous internal blood flow

50
Q
A
51
Q

Modullary carcinoma

A

A familial neoplasm derived from parafollicular C cells and secretes calcium

52
Q

What are the sonographic features of medullary carcinoma

A

Hypoechoic mass
Calcium deposits
Increased vascularity

53
Q

Anaplastic thyroid carcinoma

A

A rare aggressive thyroid cancer composed of undifferentiated follicular cells with epitheloid and or spindle cell features

54
Q

Risk factors of anaplastic carcinoma

A

Elderly patients
Usually above 50 years

55
Q

What are the sonographic findings of anaplastic carcinoma

A

Large hypoechoic mass
Ill defined
Calcifications
Invasion of surrounding soft tissue and vessels

56
Q

Thyroid lymphoma

A

Non Hodgkins type
Presents as a rapidly growing painless mass

57
Q

What are the symptoms of thyroid lymphoma

A

Obstructive symptoms such as
Dyspnea
Dysphasia

58
Q

What are the risk factors of lymphoma

A

Females older than 60
History of chronic lymphocytic disease
Subclinical or overt hypothyroidism

59
Q

What are the sonogrphic features of thyroid lymphoma

A

Hypoechoic
Lobulated/ nodular mass
Non vascular
Ill defined
Heterogenous
Large areas of cystic necrosis
Encasement of adjacent vessels

60
Q

What is acute supportive thyroiditis

A

A rare inflammatory disease caused by a bacterial infection in immunocompramised patients and children

61
Q

The presentation of acute supportive thyroiditis

A

Pain
Firmness
Tenderness
Redness
Swelling
Fever
Dysphagia
Difficulty moving neck

62
Q

Ultrasound features of acute supportive thyroiditis

A

Perithyroidial soft tissue involvement
Increased vascularity
Heterogenous ecotecture
Lymphnodes
Hypoechoic
Absess formstion

63
Q

What is subacute granulomatous thyroiditis (de Quervains disease)

A

A spontaneously remitting inflammatory disease following a viral infection such as hepatitis B/C, mumps, cytomegalovirus, adenonvirus, measels, influenza

64
Q

What is the presentation of De Quervains disease

A

Painful swelling in lower neck
Fever
Lethargy
Gradually/ fairly abrupt onset of pain
Can cause transient hypothyroidism

65
Q

Sonographic features of deep Quervain disease

A

Hypoechoic mass
Ill defined mass
Decreased vascularity
Sometimes involvement of contralateral lobes

66
Q

What is chronic lymphocytic thyroiditis (Hashimotos disease)

A

The most common thyroiditis that is characterized by a destructive autoimmune disorder which leads to chronic inflammation of the thyroid

67
Q

How does Hashimotos disease present

A

Painless
Diffusely enlarged gland
Young middle age females

68
Q

Sonographic features of Hashimotos disease

A

Acute phase
Small hypoechoic nodules
Ill defined margins
Origin in anterior portion of isthmus and thyroid

69
Q

Sonographic features of Hashimotos disease

A

Subacute
Infiltration proceeds to whole gland
Hypervascular

70
Q

Sonographic features of Hashimotos disease

A

Chronic
Enlarged Slightly
Lobulated / lobular outline
Atrophied gland small

71
Q

What is Graves disease

A

An autoimmune disorder caused by hyperthyroidism

72
Q

Risk factors of Graves disease

A

Females over 30

73
Q

What are the characteristics of Graves disease

A

Thyrotoxicosis
Hypermetabolism
Diffuse toxic goiter
Exophthalmus
Cutaneous manifistations
Hyperthyroidism

74
Q

What are the sonographic features of Graves disease

A

Enlarged
Hypoechoic
Inhomogenous
Hypervascularity

75
Q

What is the function of the parathyroid gland

A

Calsium sensing organ

76
Q

What happens when there is a decrease in the serum calcium levels

A

A decrease or drop in the serum calsiumn levels Stimulates the parathyroid gland to secrete parathyroid hormone. The parathyroid hormone acts one the bone, kidneys and instine to enhance calcium absorption.

77
Q

What transducer is used to scan the thyroid and parathyroid

A

High frequency transducer (7.5 -15 Mhz)

78
Q

What is primary hyperparathyroidism

A

A condition where there is an increase function of the parathyroid gland, to much production of hormones that leads to a loss of bone tissue

79
Q

Risk factors of primary hyperparathyroisdism

A

Women
2-3 times more likely to develop
Hyperthyroidism

80
Q

What are the characteristics of primary hyperparathyroisdism

A

Hypercalcemia
Hypercalcuria
Low serum levels of phosphate

81
Q

What conditions causes primary parathyroidysm

A

Ademonas
Primary hyperplasia
Causes increase amount of pth

82
Q

Parathyroid ademona

A

Benign tumor of parathyroid gland and most common cause of primary hyperparathyroisdism

83
Q

Sonographic features of parathyroid adenoma

A
  • Oval shape
  • Homogenous
  • Hypoechoic solid
  • Usually smaller than 3cm
  • Larger addnomas measure greater than 5 cm in length
  • Encapsulated with discrete border
  • Hypervascular
84
Q

Parathyroid carcinoma

A

A rare small irregular mass.

85
Q

What is important to the diagnostic process of parathyroid carcinoma

A

Metastases to the regional nodes, distant organs capsules invasion or local occurrence must be seen

86
Q

What are the sonogrphic features of parathyroid carcinoma

A

Larger than ademona (>3cm)
Lobular contour
Heterogenous internal architecture
Internal cystic components
Absence of suspicious vascularity

87
Q

What is secondary hyperparathyroisdism

A

Chronic hypercalcemia that is caused by renal failure, vitamin D deficiency (Rickets), or malabsorption syndromes.

88
Q

What happens in secondary hyperparathyroisdism

A

The abnormalities induces PTH secretion that leads to hypercalcemia.

89
Q

What are two examples of developmental cyst in the midline of the neck?

A

Thyroglossal duct cyst
Brachial cleft cyst

90
Q

What is a thyroglossal cyst

A

A congenital anomaly that appears at the midline of the neck anterior to the trachea.

91
Q

What is a brachial c,eft cyst

A

A cystic formation usually located laterL to thyroid gland

USP01Y2 (4 decks)

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