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Section II General Surgery P203Surgical Recall Sixth > Thyroid Gland, C58 P438-452 > Flashcards

Thyroid Gland, C58 P438-452 Flashcards

1
Q 
THYROID DISEASE
ANATOMY
Identify the following
structures:
P438 (picture)
A
  1. Pyramidal lobe
  2. Right lobe
  3. Isthmus
  4. Left lobe
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2
Q 
THYROID DISEASE
ANATOMY
Define the arterial blood
supply to the thyroid.
P438 (picture)
A

Two arteries:
1. Superior thyroid artery (first branch
of the external carotid artery)
2. Inferior thyroid artery (branch of
the thyrocervical trunk) (IMA
artery rare)

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3
Q 
THYROID DISEASE
ANATOMY
What is the venous drainage
of the thyroid?
P439 (picture)
A

Three veins:

1. Superior thyroid vein
2. Middle thyroid vein
3. Inferior thyroid vein
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4
Q 
THYROID DISEASE
ANATOMY
Name the thyroid lobe
appendage coursing toward
the hyoid bone from around
the thyroid isthmus.
P439
A

Pyramidal lobe

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5
Q 
THYROID DISEASE
ANATOMY
What percentage of patients
have a pyramidal lobe?
P439
A

≈50%

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6
Q 
THYROID DISEASE
ANATOMY
What veins do you first see
after opening the platysma
muscle when performing a
thyroidectomy?
P439
A

Anterior jugular veins

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7
Q 
THYROID DISEASE
ANATOMY
Name the lymph node
group around the pyramidal
thyroid lobe.
P439
A

Delphian lymph node group

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8
Q

THYROID DISEASE
ANATOMY
What is the thyroid isthmus?
P439

A

Midline tissue border between the left

and right thyroid lobes

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9
Q 
THYROID DISEASE
ANATOMY
Which ligament connects the
thyroid to the trachea?
P439
A

Ligament of Berry

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10
Q 
THYROID DISEASE
ANATOMY
What is the IMA (not I.M.A.)
artery?
P439
A

Small inferior artery to the thyroid from

the aorta or innominate artery

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11
Q 
THYROID DISEASE
ANATOMY
What percentage of patients
have an IMA artery?
P439
A

≈3%

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12
Q 
THYROID DISEASE
ANATOMY
Name the most posterior
extension of the lateral
thyroid lobes.
P440
A

Tubercle of Zuckerkandl

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13
Q 
THYROID DISEASE
ANATOMY
Which paired nerves must
be carefully identified
during a thyroidectomy?
P440
A 
Recurrent laryngeal nerves, which are
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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14
Q 
THYROID DISEASE
ANATOMY
What other nerve is at risk
during a thyroidectomy and
what are the symptoms?
P440
A

Superior laryngeal nerve; if damaged,
patient will have a deeper and quieter
voice (unable to hit high pitches)

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15
Q 
THYROID DISEASE
ANATOMY
What is the name of the
famous opera singer
whose superior laryngeal
nerve was injured during
thyroidectomy?
P440
A

Urban legend has it that it was Amelita
Galli-Curci, but no objective data support
such a claim (Ann Surg 233:588, April
2001)

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16
Q

THYROID DISEASE
PHYSIOLOGY
What is TRH?
P440

A

Thyrotropin-Releasing Hormone
released from the hypothalamus; causes
release of TSH

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17
Q

THYROID DISEASE
PHYSIOLOGY
What is TSH?
P440

A

Thyroid-Stimulating Hormone released
by the anterior pituitary; causes release of
thyroid hormone from the thyroid

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18
Q 
THYROID DISEASE
PHYSIOLOGY
What are the thyroid
hormones?
P440
A

T3 and T4

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19
Q 
THYROID DISEASE
PHYSIOLOGY
What is the most active form
of thyroid hormone?
P440
A

T3

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20
Q 
THYROID DISEASE
PHYSIOLOGY
What is a negative feedback
loop?
P440
A

T3 and T4 feed back negatively on the
anterior pituitary (causing decreased
release of TSH in response to TRH)

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21
Q 
THYROID DISEASE
PHYSIOLOGY
What is the most common
site of conversion of T4
to T3?
P440
A

Peripheral (e.g., liver)

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22
Q 
THYROID DISEASE
PHYSIOLOGY
What is Synthroid®
(levothyroxine): T3 or T4?
P441
A

T4

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23
Q 
THYROID DISEASE
PHYSIOLOGY
What is the half-life of
Synthroid® (levothyroxine)?
P441
A

7 days

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24
Q 
THYROID DISEASE
PHYSIOLOGY
What do parafollicular cells
secrete?
P441
A

Calcitonin

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25
Q 
THYROID DISEASE
THYROID NODULE
What percentage of people
have a thyroid nodule?
P441
A

≈5%

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26
Q 
THYROID DISEASE
THYROID NODULE
What is the differential
diagnosis of a thyroid
nodule?
P441
A 
Multinodular goiter
Adenoma
Hyperfunctioning adenoma
Cyst
Thyroiditis
Carcinoma/lymphoma
Parathyroid carcinoma
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27
Q 
THYROID DISEASE
THYROID NODULE
Name three types of
nonthyroidal neck masses.
P441
A 
1. Inflammatory lesions (e.g., abscess,
    lymphadenitis)
2. Congenital lesions (i.e., thyroglossal
    duct [midline], branchial cleft cyst
    [lateral])
3. Malignant lesions: lymphoma,
    metastases, squamous cell carcinoma
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28
Q 
THYROID DISEASE
THYROID NODULE
What studies can be used to
evaluate a thyroid nodule?
P441
A

U/S—solid or cystic nodule
Fine Needle Aspirate (FNA) →
cytology
I scintiscan—hot or cold nodule

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29
Q 
THYROID DISEASE
THYROID NODULE
What is the DIAGNOSTIC
test of choice for thyroid
nodule?
P441
A

FNA

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30
Q 
THYROID DISEASE
THYROID NODULE
What is the percentage of
false negative results on
FNA for thyroid nodule?
P441
A

≈5%

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31
Q 
THYROID DISEASE
THYROID NODULE
What is meant by a hot
versus a cold nodule?
P442
A 
Nodule uptake of IV  131I or 99mT
Hot—Increased  123I uptake = functioning/
    hyperfunctioning nodule
Cold—Decreased 123I uptake 
    nonfunctioning nodule
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32
Q 
THYROID DISEASE
THYROID NODULE
What are the indications for
a  I scintiscan?
P442
A
  1. Nodule with multiple “nondiagnostic”
    FNAs with low TSH
  2. Nodule with thyrotoxicosis and low TSH
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33
Q 
THYROID DISEASE
THYROID NODULE
What is the role of thyroid
suppression of a thyroid
nodule?
P442
A

Diagnostic and therapeutic;
administration of thyroid hormone
suppresses TSH secretion, and up to half of
the benign thyroid nodules will disappear!

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34
Q 
THYROID DISEASE
THYROID NODULE
In evaluating a thyroid nodule, which of the
following suggest thyroid carcinoma:
History?
P442
A
  1. Neck radiation
  2. Family history (thyroid cancer, MEN-II)
  3. Young age (especially children)
  4. Male > female
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35
Q 
THYROID DISEASE
THYROID NODULE
In evaluating a thyroid nodule, which of the
following suggest thyroid carcinoma:
Signs?
P442
A
  1. Single nodule
  2. Cold nodule
  3. Increased calcitonin levels
  4. Lymphadenopathy
  5. Hard, immobile nodule
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36
Q 
THYROID DISEASE
THYROID NODULE
In evaluating a thyroid nodule, which of the
following suggest thyroid carcinoma:
Symptoms?
P442
A
  1. Voice change (vocal cord paralysis)
  2. Dysphagia
  3. Discomfort (in neck)
  4. Rapid enlargement
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37
Q 
THYROID DISEASE
THYROID NODULE
What is the most common
cause of thyroid enlargement?
P442
A

Multinodular goiter

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38
Q 
THYROID DISEASE
THYROID NODULE
What are indications for
surgery with multinodular
goiter?
P442
A

Cosmetic deformity, compressive

symptoms, cannot rule out cancer

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39
Q

THYROID DISEASE
THYROID NODULE
What is Plummer’s disease?
P442

A

Toxic multinodular goiter

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40
Q 
THYROID DISEASE
MALIGNANT THYROID NODULES
What percentage of cold
thyroid nodules are
malignant?
P443
A

≈25% in adults

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41
Q 
THYROID DISEASE
MALIGNANT THYROID NODULES
What percentage of
multinodular masses are
malignant?
P443
A

≈1%

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42
Q 
THYROID DISEASE
MALIGNANT THYROID NODULES
What is the treatment of a
patient with a history of
radiation exposure, thyroid
nodule, and negative FNA?
P443
A

Most experts would remove the nodule
surgically (because of the high risk of
radiation)

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43
Q 
THYROID DISEASE
MALIGNANT THYROID NODULES
What should be done with
thyroid cyst aspirate?
P443
A

Send to cytopathology

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44
Q 
THYROID DISEASE
THYROID CARCINOMA
Name the FIVE main types
of thyroid carcinoma and
their relative percentages.
P443
A 
1. Papillary carcinoma: 80% (Popular =
    Papillary)
2. Follicular carcinoma: 10%
3. Medullary carcinoma: 5%
4. Hürthle cell carcinoma: 4%
5. Anaplastic/undifferentiated
    carcinoma: 1% to 2%
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45
Q 
THYROID DISEASE
THYROID CARCINOMA
What are the signs/
symptoms?
P443
A

Mass/nodule, lymphadenopathy; most are

euthyroid

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46
Q 
THYROID DISEASE
THYROID CARCINOMA
What comprises the
workup?
P443
A

FNA, thyroid U/S, TSH, calcium level,

CXR, +/– scintiscan I

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47
Q 
THYROID DISEASE
THYROID CARCINOMA
What oncogenes are
associated with thyroid
cancers?
P443
A

Ras gene family and RET proto-oncogene

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48
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is papillary
carcinoma’s claim to faim?
P443
A

Most common thyroid cancer (Think:
Papillary = Popular) = 80% of all
thyroid cancers

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49
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the environmental
risk?
P443
A

Radiation exposure

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50
Q

THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the average age?
P444

A

30–40 years

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51
Q

THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the sex distribution?
P444

A

Female > male; 2:1

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52
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What are the associated
histologic findings?
P444
A 
Psammoma bodies (Remember,
P = Psammoma = Papillary)
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53
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
Describe the route and rate
of spread.
P444
A

Most spread via lymphatics (cervical

adenopathy); spread occurs slowly

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54
Q

THYROID DISEASE
PAPILLARY ADENOCARCINOMA
uptake?
P444

A

Good uptake

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55
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the 10-year survival
rate?
P444
A

≈95%

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56
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the treatment for:
<1.5 cm and no history of neck radiation
exposure?
P444
A

Options:

  1. Thyroid lobectomy and isthmectomy
  2. Near-total thyroidectomy
  3. Total thyroidectomy
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57
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the treatment for:
>1.5 cm, bilateral, cervical node metastasis
OR a history of radiation
exposure?
P444
A

Total thyroidectomy

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58
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the treatment for:
Lateral palpable cervical
lymph nodes?
P444
A

Modified neck dissection (ipsilateral)

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59
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the treatment for:
Central?
P444
A

Central neck dissection

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60
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
Do positive cervical nodes
affect the prognosis?
P444
61
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is a “lateral aberrant
thyroid” in papillary cancer?
P444
A

Misnomer—it is metastatic papillary

carcinoma to a lymph node

62
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What postoperative
medication should be
administered?
P444
A

Thyroid hormone replacement, to

suppress TSH

63
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is a postoperative
treatment option for
papillary carcinoma?
P444
A

Postoperative 131I scan can locate residual
tumor and distant metastasis that can be
treated with ablative doses of 131I

64
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What is the most common
site of distant metastases?
P445
A

Pulmonary (lungs)

65
Q 
THYROID DISEASE
PAPILLARY ADENOCARCINOMA
What are the “P’s” of
papillary thyroid cancer (7)?
P445
A 
Papillary cancer:
    Popular (most common)
    Psammoma bodies
    Palpable lymph nodes (spreads most
       commonly by lymphatics, seen in
       ≈33% of patients)
    Positive 131I uptake
    Positive prognosis
    Postoperative 131I scan to
       diagnose/treat metastases
    Pulmonary metastases
66
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What percentage of thyroid
cancers does it comprise?
P445
67
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
Describe the nodule
consistency.
P445
A

Rubbery, encapsulated

68
Q

THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What is the route of spread?
P445

A

Hematogenous, more aggressive than

papillary adenocarcinoma

69
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What is the male:female
ratio?
P445
70
Q

THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
131I uptake?
P445

A

Good uptake

71
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What is the overall 10-year
survival rate?
P445
72
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
Can the diagnosis be made
by FNA?
P445
A

No; tissue structure is needed for a

diagnosis of cancer

73
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What histologic findings
define malignancy in
follicular cancer?
P445
A

Capsular or blood vessel invasion

74
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What is the most common
site of distant metastasis?
P445
75
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What is the treatment for
follicular cancer?
P445
A

Total thyroidectomy

76
Q 
c
What is the postoperative
treatment option if
malignant?
P446
A

Postoperative 131I scan for diagnosis/

treatment

77
Q 
THYROID DISEASE
FOLLICULAR ADENOCARCINOMA
What are the 4 “F’s” of
follicular cancer?
P446
A 
Follicular cancer:
    Far-away metastasis (spreads
       hematogenously)
    Female (3 to 1 ratio)
    FNA . . . NOT (FNA CANNOT
       diagnose cancer)
    Favorable prognosis
78
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is it?
P446

A

Thyroid cancer of the Hürthle cells

79
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What percentage of thyroid
cancers does it comprise?
P446
80
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the cell of origin?
P446

A

Follicular cells

81
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
131I uptake?
P446

82
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
How is the diagnosis made?
P446

A

FNA can identify cells, but malignancy
can be determined only by tissue
histology (like follicular cancer)

83
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the route of
metastasis?
P446
A

Lymphatic > hematogenous

84
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the treatment?
P446

A

Total thyroidectomy

85
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the 10-year survival
rate?
P446
86
Q 
THYROID DISEASE
MEDULLARY CARCINOMA
What percentage of all
thyroid cancers does it
comprise?
P446
87
Q 
THYROID DISEASE
MEDULLARY CARCINOMA
With what other conditions
is it associated?
P446
A

MEN type II; autosomal-dominant

genetic transmission

88
Q

THYROID DISEASE
MEDULLARY CARCINOMA
Histology?
P446

A

Amyloid (aMyloid = Medullary)

89
Q

THYROID DISEASE
MEDULLARY CARCINOMA
What does it secrete?
P446

A

Calcitonin (tumor marker)

90
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the appropriate
stimulation test?
P447
A

Pentagastrin (causes an increase in

calcitonin)

91
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
Describe the route of
spread.
P447
A

Lymphatic and hematogenous distant

metastasis

92
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
How is the diagnosis made?
P447

93
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
131I uptake?
P447

A

Poor uptake

94
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the associated
genetic mutation?
P447
A

RET proto-oncogene

95
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the female/male ratio?
P447

A

Female > male; 1.5:1

96
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the 10-year survival
rate?
P447
A

80% without LN involvement

45% with LN spread

97
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What should all patients
with medullary thyroid
cancer also be screened for?
P447
A

MEN II: pheochromocytoma,

hyperparathyroidism

98
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
If medullary thyroid
carcinoma and pheochromocytoma
are found, which
one is operated on first?
P447
A

Pheochromocytoma

99
Q

THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What is the treatment?
P447

A

Total thyroidectomy and median lymph
node dissection
Modified neck dissection, if lateral
cervical nodes are positive

100
Q 
THYROID DISEASE
HÜRTHLE CELL THYROID CANCER
What are the “M’s” of
medullary carcinoma?
P447
A 
Medullary cancer:
    MEN II
    aMyloid
    Median lymph node dissection
    Modified neck dissection if lateral
       nodes are positive
101
Q

THYROID DISEASE
ANAPLASTIC CARCINOMA
What is it also known as?
P447

A

Undifferentiated carcinoma

102
Q

THYROID DISEASE
ANAPLASTIC CARCINOMA
What is it?
P447

A

Undifferentiated cancer arising in ≈75%
of previously differentiated thyroid cancers
(most commonly, follicular carcinoma)

103
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What percentage of all
thyroid cancers does it
comprise?
P448
104
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What is the gender
preference?
P448
A

Women > men

105
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What are the associated
histologic findings?
P448
A

Giant cells, spindle cells

106
Q

THYROID DISEASE
ANAPLASTIC CARCINOMA
131I uptake?
P448

A

Very poor uptake

107
Q

THYROID DISEASE
ANAPLASTIC CARCINOMA
How is the diagnosis made?
P448

A

FNA (large tumor)

108
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What is the major
differential diagnosis?
P448
A 
Thyroid lymphoma (much better
prognosis!)
109
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What is the treatment of the following disorders:
Small tumors?
P448
A

Total thyroidectomy + XRT/chemotherapy

110
Q 
THYROID DISEASE
ANAPLASTIC CARCINOMA
What is the treatment of the following disorders:
Airway compromise?
P448
A

Debulking surgery and tracheostomy,

XRT/chemotherapy

111
Q

THYROID DISEASE
ANAPLASTIC CARCINOMA
What is the prognosis?
P448

A

Dismal, because most patients are at
stage IV at presentation (3% alive at
5 years)

112
Q 
THYROID DISEASE
MISCELLANEOUS
What laboratory value must
be followed postoperatively
after a thyroidectomy?
P448
A 
Calcium decreased secondary to
parathyroid damage; during lobectomy,
the parathyroids must be spared and
their blood supply protected; if blood
supply is compromised intraoperatively,
they can be autografted into the
sternocleidomastoid muscle or forearm
113
Q 
THYROID DISEASE
MISCELLANEOUS
What is the differential
diagnosis of postoperative
dyspnea after a
thyroidectomy?
P448
A

Neck hematoma (remove sutures and
clot at the bedside)
Bilateral recurrent laryngeal nerve
damage

114
Q 
THYROID DISEASE
MISCELLANEOUS
What is a “lateral aberrant
rest” of the thyroid?
P448
A

Misnomer: It is papillary cancer of a

lymph node from metastasis

115
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
What is the most common
cause of hyperthyroidism?
P449
A

Graves’ disease

116
Q

THYROID DISEASE
BENIGN THYROID DISEASE
What is Graves’ disease?
P449

A

Diffuse goiter with hyperthyroidism,

exophthalmos, and pretibial myxedema

117
Q

THYROID DISEASE
BENIGN THYROID DISEASE
What is the etiology?
P449

A 
Caused by circulating antibodies that
stimulate TSH receptors on follicular
cells of the thyroid and cause deregulated
production of thyroid hormones (i.e.,
hyperthyroidism)
118
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
What is the female:male
ratio?
P449
119
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
What specific physical
finding is associated with
Graves’?
P449
A

Exophthalmos

120
Q

THYROID DISEASE
BENIGN THYROID DISEASE
How is the diagnosis made?
P449

A

Increased T3, T4, and anti-TSH receptor
antibodies, decreased TSH, global uptake
of 131I radionuclide

121
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
Name treatment option
modalities for Graves’
disease.
P449
A 
1. Medical blockade: iodide,
    propranolol, propylthiouracil (PTU),
    methimazole, Lugol’s solution
    (potassium iodide)
2. Radioiodide ablation: most popular
    therapy
3. Surgical resection (bilateral subtotal
    thyroidectomy)
122
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
What are the possible
indications for surgical
resection?
P449
A

Suspicious nodule; if patient is
noncompliant or refractory to medicines,
pregnant, a child, or if patient refuses
radioiodide therapy

123
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
What is the major
complication of radioiodide
or surgery for Graves’
disease?
P449
A

Hypothyroidism

124
Q

THYROID DISEASE
BENIGN THYROID DISEASE
What does PTU stand for?
P449

A

PropylThioUracil

125
Q

THYROID DISEASE
BENIGN THYROID DISEASE
How does PTU work?
P450

A 
1. Inhibits incorporation of iodine into
    T4/T3 (by blocking peroxidase
    oxidation of iodide to iodine)
2. Inhibits peripheral conversion of T4
    to T3
126
Q 
THYROID DISEASE
BENIGN THYROID DISEASE
How does methimazole
work?
P450
A

Inhibits incorporation of iodine into
T4/T3 only (by blocking peroxidase
oxidation of iodide to iodine)

127
Q

THYROID DISEASE
TOXIC MULTINODULAR GOITER
What is it also known as?
P450

A

Plummer’s disease

128
Q

THYROID DISEASE
TOXIC MULTINODULAR GOITER
What is it?
P450

A

Multiple thyroid nodules with one or
more nodules producing thyroid hormone,
resulting in hyperfunctioning thyroid
(hyperthyroidism or a “toxic” thyroid state)

129
Q 
THYROID DISEASE
TOXIC MULTINODULAR GOITER
What medication may bring
on hyperthyroidism with a
multinodular goiter?
P450
A

Amiodarone (or any iodine-containing

medication/contrast)

130
Q 
THYROID DISEASE
TOXIC MULTINODULAR GOITER
How is the hyperfunctioning
nodule(s) localized?
P450
A

131I radionuclide scan

131
Q

THYROID DISEASE
TOXIC MULTINODULAR GOITER
What is the treatment?
P450

A

Surgically remove hyperfunctioning
nodule(s) with lobectomy or near total
thyroidectomy

132
Q

THYROID DISEASE
TOXIC MULTINODULAR GOITER
What is Pemberton’s sign?
P450

A

Large goiter causes plethora of head with

raising of both arms

133
Q 
THYROID DISEASE
THYROIDITIS
What are the features of
ACUTE thyroiditis?
P450
A

Painful, swollen thyroid; fever; overlying

skin erythema; dysphagia

134
Q 
THYROID DISEASE
THYROIDITIS
What is the cause of ACUTE
thyroiditis?
P450
A

Bacteria (usually Streptococcus or
Staphylococcus), usually caused by a
thyroglossal fistula or anatomic variant

135
Q 
THYROID DISEASE
THYROIDITIS
What is the treatment of
ACUTE thyroiditis?
P450
A

Antibiotics, drainage of abscess, needle
aspiration for culture; most patients need
definitive surgery later to remove the fistula

136
Q 
THYROID DISEASE
THYROIDITIS
What are the features of
SUBACUTE thyroiditis?
P451
A

Glandular swelling, tenderness, often

follows URI, elevated ESR

137
Q 
THYROID DISEASE
THYROIDITIS
What is the cause of
SUBACUTE thyroiditis?
P451
A

Viral infection

138
Q 
THYROID DISEASE
THYROIDITIS
What is the treatment of
SUBACUTE thyroiditis?
P451
A

Supportive: NSAIDS, ± steroids

139
Q 
THYROID DISEASE
THYROIDITIS
What is De Quervain’s
thyroiditis?
P451
A

Just another name for SUBACUTE
thyroiditis caused by a virus (Think:
De QuerVain = Virus)

140
Q 
THYROID DISEASE
THYROIDITIS
How can the differences
between etiologies of
ACUTE and SUBACUTE
thyroiditis be remembered?
P451
A

Alphabetically: A before S, B before V
(i.e., Acute before Subacute and
Bacterial before Viral and thus: Acute =
Bacterial and Subacute = Viral)

141
Q 
THYROID DISEASE
THYROIDITIS
What are the common
causative bacteria in acute
suppurative thyroiditis?
P451
A

Streptococcus or Staphylococcus

142
Q 
THYROID DISEASE
THYROIDITIS
What are the two types of
chronic thyroiditis?
P451
A
  1. Hashimoto’s thyroiditis

2. Riedel’s thyroiditis

143
Q 
THYROID DISEASE
THYROIDITIS
What are the features of
Hashimoto’s (chronic)
thyroiditis?
P451
A

Firm and rubbery gland, 95% in women,

lymphocyte invasion

144
Q 
THYROID DISEASE
THYROIDITIS
What is the claim to fame of
Hashimoto’s disease?
P451
A

Most common cause of hypothyroidism

in the United States

145
Q 
THYROID DISEASE
THYROIDITIS
What is the etiology of
Hashimoto’s disease?
P451
A

Autoimmune (Think: HashimOTO =

AUTO; thus, Hashimoto = autoimmune)

146
Q 
THYROID DISEASE
THYROIDITIS
What lab tests should be
performed to diagnose
Hashimoto’s disease?
P451
A

Antithyroglobulin and microsomal

antibodies

147
Q 
THYROID DISEASE
THYROIDITIS
What is the medical
treatment for Hashimoto’s
thyroiditis?
P451
A

Thyroid hormone replacement if
hypothyroid (surgery is reserved for
compressive symptoms and/or if cancer
needs to be ruled out)

148
Q

THYROID DISEASE
THYROIDITIS
What is Riedel’s thyroiditis?
P452

A

Benign inflammatory thyroid
enlargement with fibrosis of thyroid
Patients present with painless, large thyroid
Fibrosis may involve surrounding tissues

149
Q 
THYROID DISEASE
THYROIDITIS
What is the treatment for
Riedel’s thyroiditis?
P452
A

Surgical tracheal decompression, thyroid
hormone replacement as needed—
possibly steroids/tamoxifen if refractory

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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