Thyroid/Parathyroid 2 Flashcards
causes of benign thyroid nodules
- Multinodular goiter
- Hashimoto’s thyroiditis
- Cysts
- Follicular adenomas
causes of malignant thyroid nodules
CANCER
higher concern of thyroid nodules in what scenarios?
– kids, men, adults <30 y/o & >60 y/o
–hx of head/neck radiation
–hx hematopoeitic stem cell transplant (HSC)
–family hx thyroid cancer
–Size > or equal to 2cm
thyroid nodules approach
H&P
TSH
Thyroid US
procedure of choice to evaluate thyroid nodules
FNA bx
what size of thyroid nodule do you need multiple samples with?
Large nodules (>4 cm)
what 2 ways can you do a FNA?
palpation or U/S guided
General Indications for FNA
RECOMMENDED FOR THE FOLLOWING:
- High risk hX & > 5 mm
- Abnormal cervical lymph nodes
- Micro-calcifications: ≥ 1 cm
indications for FNA Bx if solid nodule
Hypoechoic, > 1 cm
Iso- or hyperechoic, ≥ 1 to 1.5 cm
indications for FNA Bx if mixed-cystic-solid thyroid nodule
w/ suspicious u/s: ≥ 1.5 to 2.0 cm
w/o suspicious u/s: ≥ 2.0 cm
is a FNA bx recommended in a spongiform thyroid nodule?
if ≥ 2.0 cm, YES
is a FNA Bx indicated for a purely cystic thyroid nodule?
NO
mgmt of benign FNA
–Repeat U/S 6-18 months to assess stability
–Growth > 20% - repeat FNA
thyroid CA is more common in (men/women)?
women
what demographics have worse prognosis of thyroid carcinoma?
<20 age > 45 & Male sex
RF of thyroid carcinoma
- Hx of childhood head or neck irradiation
- Thyroid cancer in first degree relative
- Large nodule size (≥ 4 cm)
MC type of thyroid CA
papillary
what type of thyroid CA has poor prognosis?
anaplastic
which type of thyroid CA should you test for RET mutations as a genetic marker?
medullary
Mets from what other sites could cause Thyroid CA?
Breast, colon, renal, melanoma
tx for thyroid Carcinoma
- Surgery: Near total thyroidectomy
- TSH Suppression: Levothyroxine
- Radioiodine ablation
- Chemotherapy
- Palliative external radiotherapy
thyroid carcinoma post-tx mgmt
–Serum thyroglobulin level, anti-thyroglobulin antibodies
–Neck ultrasound
–Serum TSH level
–MRI, CT, PET as appropriate
function of parathyroid gland?
–Parathyroid hormone secretion to help regulate calcium homeostasis
–Also helps regulate phosphate
–Negative feedback with calcium sensing receptor on surface of
parathyroid cells
MCC of hypoparathyroidism
acquired: usually occurs post-thyroidectomy
Other causes of hypoparathyroidism
autoimmune
congenital
•Tetany
•Muscle cramps
•Caropopedal spasm
•Irritability
•Altered mental status
- Convulsions
- Stridor
•Paresthesias of circumoral area/hands/feet
•Chvostek sign
•Trousseau phenomenon
- Cataracts
- Thin/brittle nails
- Dry, scaly skin
•Candidiasis
•Loss of eyebrows
•Hyperactive DTRs
Clinical px of what?
hypoparathyroidism
hypoparathyroidism dx
low Ca2+, urinary Ca2+, PTH, Mg (can be normal)
high phosphate
normal alk phos
hypoparathyroidism emergency tx
–IV calcium gluconate plus oral calcitriol: Wean to oral calcium
–Airway maintenance
hypoparathyroidism maintenance tx
–Oral calcium and vitamin D supplementation
–Avoid hypercalcemia
–2nd line tx: recombinant hPTH
MCC of hyperparathyroidism
parathyroid adenoma
cause of secondary or tertiary hyperparathyroidism
Chronic renal failure: Hyperphosphatemia and ↓renal vitamin D production → ↓ ionized calcium, which stimulates the parathyroids
Renal osteodystrophy
Asymptomatic hypercalcemia
“bones, stones, abdominal groans, and psychiatric moans”
clinical px of what?
hyperparathyroidism
hyperparathyroidism dx
Elevated calcium, serum PTH level
Urinary calcium excretion normal or elevated
hyperparathyroidism tx
Surgical resection is definitive.
Parathyroidectomy
_May be hypocalcemic post-op***_
hyperparathyroidism conservative tx
–Physical activity
–Drink adequate fluids
–Avoid lithium and HCTZ
–Restrict calcium intake to 1000 mg/day
–Vitamin D 400-600 IU daily
–Monitor
pharamcologic tx for prmary hyperparathyroidism
–IV bisphosphonates can temporarily ↓ hypercalcemia and treat bone painL Zoledronic acid (Reclast)
pharmacologic tx for secondary or tertiary hyperparathyroidism
–Cinacalcet (Sensipar), paricalcitol (Zemplar)
