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COMAT: Surgery > Thyroid Gland > Flashcards

Thyroid Gland Flashcards

1
Q

define the artery supply to the thyroid?

A

superior thyroid artery
- first branch of external carotid artery
inferior thyroid artery
- branch of the thyrocervical trunk

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2
Q

what is the venous drainage of the thyroid?

A

superior thyroid vein
middle thyroid vein
inferior thyroid vein

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3
Q

name the thyroid lobe appendage coursing toward the hyoid bone from around the thyroid isthmus?

A

pyramidal lobe

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4
Q

name the lymph node group around the pyramidal thyroid lobe

A

delphian LN group

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5
Q

what is the thyroid isthmus?

A

midline tissue border between the left and right thyroid lobes

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6
Q

which ligament connects the thyroid to the trachea?

A

ligament of berry

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7
Q

which paired nerves must be carefully identified during a thyroidectomy?

A

recurrent laryngeal nerves

  • found in the tracheoesophageal grooves and dive behind the cricothyroid muscle
  • damage to these nerves paralyzes laryngeal abductors and causes hoarseness if unilateral and airway obstruction if bilateral
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8
Q

what other nerve is at risk during a thyroidectomy and what are the symptoms?

A

superior laryngeal nerve

- if damaged, patient will have a deeper and quieter voice

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9
Q

What is TRH?

A

thyrotropin-releasing hormone

  • released from hypothalamus
  • causes release of TSH
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10
Q

what is TSH?

A

thyroid-stimulating hormone

  • released by anterior pituitary
  • causes release of thyroid hormone from the thyroid
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11
Q

what are the thyroid hormones?

A

T3 and T4

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12
Q

what is the most active form of thyroid hormone?

A

T3

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13
Q

what is the negative feedback loop?

A

T3 and T4 feedback negatively on the anterior pituitary

- cause decreased release of TSH in response to TRH

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14
Q

what do parafollicular cells secrete?

A

calcitonin

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15
Q

what is the differential diagnosis of a thyroid nodule?

A 
multi nodular goiter
adenoma
hyperfunctioning adenoma
cyst
thyroiditis
carcinoma/lymphoma
parathyroid carcinoma
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16
Q

name three types of non thyroidal neck masses

A

inflammatory lesions: abscess, lymphadenitis
congenital lesions: thyroglossal duct, branchial cleft cyst
malignant lesions: lymphoma, metastases, squamous cell carcinoma

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17
Q

what is the diagnostic test of choice for thyroid nodule?

A

FNA

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18
Q

what in a history suggests thyroid carcinoma?

A

neck radiation
family history
young age
male>female

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19
Q

what signs suggest thyroid carcinoma?

A 
single nodule
cold nodule
increased calcitonin
lymphadenopathy
hard, immobile nodule
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20
Q

what symptoms suggest thyroid carcinoma?

A

voice change (vocal cord paralysis)
dysphagia
discomfort
rapid enlargement

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21
Q

what is the most common cause of thyroid enlargement?

A

multinodular goiter

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22
Q

What is Plummer’s disease?

A

toxic multi nodular goiter

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23
Q

what is the treatment of a patient with a history of radiation exposure, thyroid nodule, and negative FNA?

A

remove the nodule with thyroid lobectomy

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24
Q

name the five main types of thyroid carcinoma

A
  • papillary carcinoma
  • follicular carcinoma
  • medullary carcinoma
  • Hürthle cell carcinoma
  • anaplastic/undifferentiated carcinoma
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25
Q

what are the signs/symptoms of thyroid carcinoma?

A

mass/nodule, lymphadenopathy

- most are euthyroid

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26
Q

what is a papillary carcinoma’s claim to fame?

A

most common thyroid cancer

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27
Q

what is the environmental risk of papillary adenocarcinoma?

A

radiation exposure

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28
Q

what are the associated histologic signs of papillary adenocarcinoma?

A

psammoma bodies
- round microscopic calcific
papillae lined by cells with clear, ‘orphan Annie eye’ nuclei and nuclear grooves

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29
Q

what postoperative medication should be administered for papillary adenocarcinoma?

A

thyroid hormone replacement, to suppress TSH

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30
Q

what is the most common site of metastases in papillary adenocarcinoma?

A

pulmonary (lungs)

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31
Q

describe the nodule consistent of follicular adenocarcinoma

A

rubbery, encapsulated

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32
Q

can the diagnosis of follicular adenocarcinoma be made by FNA?

A

no

- tissue structure is needed for a diagnosis of cancer

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33
Q

what histologic findings define malignancy in follicular adenocarcinoma?

A

capsular or blood vessel invasion

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34
Q

what is the most common site of distant metastasis in follicular adenocarcinoma?

35
Q

what is a Hürthle cell thyroid cancer?

A

thyroid cancer of the Hürthle cells

36
Q

what is the cell of origin for Hürthle cell thyroid cancer?

A

follicular cells

37
Q

how is the diagnosis made of Hürthle cell thyroid cancer?

A

FNA can identify cells, but malignancy can be determined only by tissue histology

38
Q

what is the route of metastasis for Hürthle cell thyroid cancer?

A

lymphatic > hematogenous

39
Q

what is the treatment of Hürthle cell thyroid cancer?

A

total thyroidectomy

40
Q

with what other conditions is medullary thyroid carcinoma associated?

A

MEN-II

- Autosomal Dominant

41
Q

what is the histology of medullary thyroid carcinoma?

A

amyloid stroma

42
Q

what does medullary thyroid carcinoma secrete?

A

calcitonin

43
Q

what is the appropriate stimulation test of medullary thyroid carcinoma?

A

pentagastrin

- causes an increase in calcitonin

44
Q

describe the route of spread of medullary thyroid carcinoma

A

lymphatic and hematogenous to distant metastasis

45
Q

how is the diagnosis of medullary thyroid carcinoma made?

46
Q

what is the associated genetic mutation with medullary thyroid carcinoma?

A

RET proto-oncogene

47
Q

if medullary thyroid carcinoma and pheochromocytoma are found, which one is operated on first?

A

pheochromocytoma

48
Q

what is the treatment of medullary thyroid carcinoma?

A

total thyroidectomy and median LN dissection

49
Q

what are the M’s of medullary thyroid carcinoma?

A

MEN-II
aMyloid
Median LN dissection
Modified neck dissection if lateral nodes are positive

50
Q

what is anaplastic carcinoma also known as?

A

undifferentiated carcinoma

51
Q

what are the associated histologic findings of anaplastic carcinoma?

A

giant cells, spindle cells

52
Q

how is diagnosis of anaplastic carcinoma made?

A

FNA (large tumor)

53
Q

what is the major differential diagnosis of anaplastic carcinoma?

A

thyroid lymphoma

54
Q

what is the treatment of anaplastic carcinoma small tumors?

A

total thyroidectomy + XRT/chemotherapy

55
Q

what is the treatment of anaplastic carcinoma with airway compromise?

A

debulking surgery and tracheostomy, XRT/chemotherapy

56
Q

what lab value must be followed postoperatively after a thyroidectomy?

57
Q

what is the differential diagnosis of postoperative dyspnea after a thyroidectomy?

A

neck hematoma

bilateral recurrent laryngeal nerve damage

58
Q

what is the most common cause of hyperthyroidism?

A

Graves’ disease

59
Q

What is Graves’ disease?

A

diffuse goiter with hyperthyroidism, exophthalmos, and pretibital myxedema

60
Q

what is the etiology of Graves’ disease?

A

caused by circulating antibodies that stimulate TSH receptors on follicular cells of the thyroid

61
Q

what specific physical finding is associated with Graves’?

A

exophthalmos

62
Q

how is the diagnosis of Graves’ disease made?

A

increase T3, T4, and anti-TSH receptor antibodies

decreased TSH

63
Q

name treatment option modalities for Graves’ disease

A

medical blockade: iodide, propranolol, PTU, methimazole, potassium iodide
radioiodide ablation: most popular
surgical resection: bilateral subtotal thyroidectomy

64
Q

what are the possible indications for surgical resection of Graves’ disease?

A

suspicious nodule

if patient is noncompliant or refractory to medication, pregnant, a child, or if patient refuses radio iodide therapy

65
Q

what is the major complication of radio iodide or surgery for Graves’ disease?

A

hypothyroidism

66
Q

what does PTU stand for?

A

propylthiouracil

67
Q

how does PTU work?

A

inhibits incorporation of iodine into T4/T3 by blocking peroxidase oxidation of iodide to iodine
inhibits peripheral conversion of T4 to T3

68
Q

how does methimazole work?

A

inhibits incorporation of iodine into T4/T3 only

69
Q

what is toxic multinodular goiter also known as?

A

Plummer’s disease

70
Q

what is toxic multinodular goiter?

A

multiple thyroid nodules with one or more nodules producing thyroid hormone
- resulting in hyper functioning thyroid

71
Q

what medication may bring on hyperthyroidism with a toxic multinodular goiter?

A

amiodarine

72
Q

what is the treatment of toxic multinodular goiter?

A

surgically remove hyperfunctioning nodule(s)

73
Q

what are the features of acute thyroiditis?

A

painful, swollen thyroid
fever
overlaying skin erythema
dysphagia

74
Q

what is the cause of acute thyroiditis?

A

bacteria (strep or staph)

- usually caused by thyroglossal fistula

75
Q

what is the treatment of acute thyroiditis?

A

antibiotics, drainage of abscess, needle aspiration for culture, most patients need definitive surgery

76
Q

what are the features of subacute thyroiditis?

A

glandular swelling, tenderness, often follows URI, elevated ESR

77
Q

what is the cause of subacute thyroiditis?

A

viral infection

78
Q

what is the treatment of subacute thyroiditis?

A

supportive

- NSAIDs, steroids

79
Q

what is DeQuervain’s thyroiditis?

A

another name for subacute thyroiditis

80
Q

what are the two types of chronic thyroiditis?

A

Hashimoto’s thyroiditis

Riedel’s thyroiditis

81
Q

what is the etiology of Hashimoto’s disease

A

autoimmune

82
Q

what is Riedel’s thyroiditis?

A

bening inflammatory thyroid enlargement with fibrosis of thyroid

  • present with painless, large thyroid
  • fibrosis may involve surrounding tissues
83
Q

what is the treatment for Riedel’s thyroiditis?

A

surgical tracheal decompression’

thyroid hormone replacement PRN

COMAT: Surgery (17 decks)

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