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MBChB Surgery > Thyroid goiter > Flashcards

Thyroid goiter Flashcards

1
Q

Define a thyroid goiter

A

Abnormal enlargement of the thyroid gland

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2
Q

Name common causes of thyroid goiter

A

Iodine deficiency
Autoimmune disorders
- Hashimotor’s
- Grave’s

Other

  • thyroid cyst
  • thyroid adenoma
  • thyroid carcinoma
  • ingestion of goitrogens
  • congenital
  • pituitary adenoma
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3
Q

Define a thyroid nodule

A

A discrete lesion within the thyroid gland that is radiologically distinct from the surrounding normal thyroid parenchyma

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4
Q

Name clinical features of hyperthyroidism

A
  1. Ocular
    - lid lag
    - lid retraction
    - Grave’s ophthalmopathy (exophthalmos, periorbital edema)
  2. Vocal
    - tremulous voice
  3. Dermatological
    - warm, moist skin
    - hyperhidrosis
    - pretibial myxedema
    - fine hair
    - diffuse hair loss
    - onycholysis
  4. Thyroid
    - diffuse smooth, non-tender goiter
    - audible bruit (Grave’s)
  5. Metabolic
    - heat intolerance
    - weakness
    - fatigue
    - weight loss
  6. CVS
    - tachycardia
    - palpitations
    - hypertension with widened pulse pressure
    - atrial fibrillation
    - chest pain
  7. MSK
    - hyperthyroid myopathy
    - osteopathy
  8. GIT
    - frequent bowel movements
  9. Reproductive
    - females (amenorrhoea, anovulation, dysfunctional uterine bleeding)
    - males (gynecomastia, libido issues, infertility ED)
  10. Neuropsychiatric
    - anxiety
    - restlessness
    - insomnia
    - tremors
    - hyperreflexia
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5
Q

Name symptoms of hypothyroidism

A
  1. Ocular
    - periorbital edema
  2. Vocal
    - hoarse voice
    - dysarthria
  3. Dermatological
    - cold, dry skin
    - hypohydrosis
    - coarse hair
    - hair loss
    - brittle nails
  4. Thyroid
    - goiter
    - atrophic
  5. Metabolic
    - cold intolerance
    - fatigue
    - weight gain
  6. CVS
    - bradycardia
    - myxedematous heart disease (dilated cardiomyopathy, dyspnea)
    - decreased CO
  7. MSK
    - hypothyroid myopathy
    - entrapment syndromes
    - myoedema
  8. GIT
    - constipation
  9. Reproductive
    - females (abnormal menstruation, galactorrhea)
    - males (ED, decreased libido, infertility)
  10. Neuropsychiatric
    - impaired cognition
    - depression
    - hyporeflexia
    - Woltman sign
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6
Q

Name important factors when taking a history in a thyroid goiter patient

A 
Age
Duration
Rapidity of growth
Family history
Personal history of RT
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7
Q

What is Berry sign?

A

Absence of distal carotid pulsation -> malignancy

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8
Q

What is Pemburton sign?

A

Bilateral arm elevation -> facial plethora

Indicates venous obstruction in goiter

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9
Q

Name lab findings in primary hyperthyroidism

A

TSH decrease

T3/4 increase

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10
Q

Name lab findings in secondary hyperthyroidism

A

TSH increase

T3/4 increase

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11
Q

Name lab findings in primary hypothyroidism

A

TSH increase

T3/4 decrease

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12
Q

Name lab findings in secondary hypothyroidism

A

TSH decrease

T3/4 decrease

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13
Q

Which thyroid diagnosis requires a radioisotope scan?

A

Primary hyperthyroidism

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14
Q

Name causes of increased uptake radioisotope scan

A

Grave’s
Autonomous nodule
Plummer’s disease

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15
Q

Name causes of normal uptake radioisotope scan

A

Thyroiditis
Drug-induced
Factitious

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16
Q

What kind of nodules can a radioisotope scan show?

A

Hot (hyperfunctioning)
Warm (iso-functioning)
Cold (non-functioning)

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17
Q

Which nodule has a risk of malignancy?

A

Cold nodule

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18
Q

Which serum test should be performed in suspected medullary thyroid cancer?

A

Serum calcitonin

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19
Q

Why should U/S be performed before biopsy?

A

To prevent distortion of the thyroid architecture

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20
Q

Which system is used to classify thyroid U/S findings?

A

TIRADS

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21
Q

Which system is used to report thyroid cytopathology?

A

Bethesda

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22
Q

Discuss the Bethesda system

A
  1. Unsatisfactory
  2. Benign
  3. Atypia/follicular lesion of undetermined significance
  4. Follicular neoplasm
  5. Suspicious for malignancy
  6. Malignancy
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23
Q

Name the 4 common types of thyroid cancer

A

Papillary
Follicular
Medullary
Anaplastic

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24
Q

Which is the most common thyroid cancer?

A

Papillary

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25
Q

How does papillary thyroid carcinoma spread?

A

Lymphatically

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26
Q

How does follicular thyroid carcinoma spread?

A

Haematogenously

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27
Q

What is medullary carcinoma associated with?

A

MEN syndrome type 2A and type 2B

28
Q

What is the average survival time in anaplastic thyroid carcinoma?

A

3-6m

29
Q

Name complications of thyroid surgery

A

Recurrent laryngeal nn injury
Ext br superior laryngeal nn injury
Hypoparathyroidism
Hemorrhage

30
Q

Name indications for thyroid surgery

A

Compression symptoms
Cosmetic
Failed medical treatment
Large retrosternal goiter

31
Q

Give 2 reasons for post-thyroidectomy thyroid hormone replacement therapy

A
  1. Prevents hypothyroidism

2. Suppresses microscopic malignancy

32
Q

Name adjuvant treatments for thyroid carcinoma

A

Radioactive iodine ablation

Suppression therapy

33
Q

Which adjuvant therapy is used in medullary thyroid carcinoma?

A

EBRT

Intensity modulated RT

34
Q

How do you F/U medullary carcinoma?

A

TSH
Calcitonin
CEA

35
Q

What is the epidemiology of thyroid goiter?

A

F>M

Decreases with age

36
Q

What is the weight of a normal adult thyroid gland?

A

20-30g

37
Q

What is the volume of a normal adult thyroid gland?

A

7-10ml

38
Q

What is the location of the thyroid gland?

A

Caudal to larynx surrounding the anterolateral part of the trachea

39
Q

How can goiters be differentiated?

A
  1. Morphology
  2. Thyroid function
  3. Dignity
40
Q

How can goiters be classified according to morphology?

A
  1. Diffuse

2. Nodular

41
Q

Name causes of a diffuse goiter

A

Grave’s
Hashimoto’s
Pituitary adenoma
Iodine deficiency

42
Q

Name causes of a nodular goiter

A

Cysts
Adenoma
Cancer

43
Q

How can goiters be classified according to thyroid function?

A

Nontoxic
Toxic
Hypothyroid

44
Q

Name causes of a nontoxic thyroid goiter

A

Iodine deficiency

45
Q

Name causes of a toxic thyroid goiter

A

Grave’s

Toxic multinodular

46
Q

Name causes of a hypothyroid thyroid goiter

A

Hashimoto’s

Congenital hypothyroid

47
Q

Name clinical features of thyroid goiter

A 
Asymptomatic 
Hyperthyroid symptoms
Hypothyroid symptoms
Obstructive symptoms
LN enlargement
Berry sign
Pemberton sign
Carotid bruit and palpable thrill (Grave's)
48
Q

How can you diagnose a thyroid goiter?

A
  1. Palpation
  2. Bloods (TSH, antibodies, calcitonin)
  3. Imaging (U/S, CT, MRI)
  4. FNA
49
Q

How is goiter classified by palpation?

A

0 - not palpable or visible
1 - palpable but not visible
2 - palpable and clearly visible

50
Q

Name causes of primary hypothyroidism

A 
Hashimoto's thyroiditis
Iatrogenic
Anti-thyroid medication
- amiodarone
- lithium
Thyroiditis
- silent thyroiditis
- subacute granulomatous thyroiditis
- postpartum thyroiditis
51
Q

Name causes of secondary hypothyroidism

A

Pituitary adenoma
Iatrogenic
Infiltrative disease

52
Q

Name causes of tertiary hypothyroidism

A

Hypothalamic disorders

53
Q

Name causes of euthyroid sick syndrome

A

Severe illness

Severe physical stress

54
Q

Name causes of primary hyperthyroidism

A 
Grave's disease
Toxic MNG
Toxic adenoma
Postpartum thyroiditis
De Quervain thyroiditis
55
Q

Name causes of secondary hyperthyroidism

A

Thyrotropic adenoma

56
Q

What genetic factors are medullary carcinomas associated with?

A

RET gene mutation (MEN 2)

Familial medullary carcinoma

57
Q

What genetic factors are papillary carcinomas associated with?

A

RET/PTC rearrangement

BRAF mutation

58
Q

What genetic factors are follicular carcinomas associated with?

A

PAX8-PPAR-gamma rearrangement

RAS mutation

59
Q

What genetic factors are anaplastic carcinomas associated with?

A

TP53 mutation

60
Q

Name red flags for thyroid cancer

A 
Male sex
Age <14 or >70
RT history
Family history (MEN2, thyroid, Gardner syndrome)
Rapid growth
Firm, fixed nodule
Cervical lymphadenopathy
61
Q

Name histological findings in papillary thyroid cancer

A

Psammoma bodies
Orphan Annie eyes nuclei
Nuclear grooves

62
Q

Name histological findings in follicular thyroid cancer

A

Uniform follicles

Vascular/capsular invasion

63
Q

Name histological findings in medullary thyroid cancer

A 
Ovoid cells of C cell origin
Stromal amyloid (Congo red stain)
64
Q

Name histological findings in anaplastic thyroid cancer

A

Undifferentiated giant cells

65
Q

Name indications for total thyroidectomy

A

Well-differentiated carcinoma
Medullary carcinoma
Resectable anaplastic

66
Q

Name contraindications for hemithyroidectomy

A

Intrathyroidal tumour >4cm
No extrathyroidal spread
No distant/nodal metastasis
No high-risk patient factors

MBChB Surgery (38 decks)

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