Thyroid/Parathyroid Flashcards
mobile midline neck mass
thyroglossal duct cyst (remnant of thyroglossal duct)
exophthalmos, thyroid
bruits, pretibial myxedema
hyperthyroid/graves
pathophys of graves dz
disease (diffuse toxic
goiter): autoimmune dz due to
TSI (anti-TSH) → hyperthyroid
diffuse toxic goiter is aka
graves dz
treatment for hyperthyroid
PTU (pregnant)
methimazole (not pregnant)
oral radioiodine (can become hypothyroid) subtotal thyroidectomy (permanent)
what is plummer disease?
Dx? tx?
multiple hyperfunctioning areas in thyroid → hyperthyroid sx
Dx ↓TSH, ↑free T4 + patchy uptake on T3 scan
Tx oral radioiodine (2 cm)
weakness, weight loss, atrial fibrillation
hyperthyroidism in the elderly
↓TSH, ↑free T4 + hot nodule on T3 scan
tx?
Toxic adenoma: single hyperfunctioning nodule → hyperthyroid sx
Tx oral radioiodine (2 cm)
marked fever, tachycardia, agitation, GI sx
tx? prognosis?
Thyroid storm
β-blockers + antithyroid drugs
20% mortality rate
autoimmune dz w/ lymphocytic
infiltration → hypothyroid sx
tx?
Hashimoto thyroiditis:
synthroid
Abs present in hashimotos
anti-TSH, antimicrosomal,
anti-thyroglobulin,
anti-peroxidase (TPO)
painful granulomatous inflammation following viral URI → hypothyroid sx
tx?
Tx NSAIDs + observation (will self-resolve)
painful, swollen, tender thyroid mass → hypothyroid sx
cause? tx?
Acute thyroiditis: will see ↑TSH, ↓/nl free T4
**due to Staph/Strep infx **
Tx: I&D
firm, painless thyroid → hypothyroid sx
tx?
Riedel thyroiditis
tx: synthroid vs surgery
marked hypothermia, ∆MS, respiratory depression
tx?
myxedema coma
Tx IV thyroxine + hydrocortisone + supportive care
MC type of thyroid nodule?
benign colloid nodule
signs that a thyroid nodule is likely malignant
-solid nodules
-cold nodules (lack of radioiodine
uptake)
-size >1.5 cm
thyroid nodule + normal TSH, what is the next step?
FNA
if the FNA of a thyroid nodule comes back indeterminate, what is the next step?
throid scn to determine if hot or cold,
hot = obsv
cold = surgery
types of thyroid cancer in order of MC and LC
80% papillary, 15% follicular, 4% medullary, 1% anaplastic
RF for developing thyroid cancer?
post radiation (papillary_ MEN2 (medullary)
how does papillary vs follicuar vs medullary thyroid cancer spread?
papillary and meullary = lymphatic
follicular = hematogenous
“Psamomma bodies w/ Orphan Annie nuclei”
papillary thryroid cancer
throid nodule with amyloid deposits
medullary cancer
follicualr thyroid cancer is MC seen
in paces with endemic iodine deficiency
aggressive , lymphatic-spreading variant of follicular cancer
Hürthle cell cancer
treatment for papillary vs follicuar vs medullary vs anaplastic thyroid cancer
+ what do you follow for reoccurance?
papillary: total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
• f/u thyroglobulin levels
follicular: hemilobectomy + frozen bx → totalthyroidectomy if bx shows carcinoma
• f/u thyroglobulin levels
medullary: total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
• f/u calcitonin levels + 24-hr urinary VMA (bc MEN2 w/ pheo)
anaplastic = palliative care
How is px of thyroid cancer determined?
MACIS system –
Metastasis
Age (2 cm)
complications of thyroid surgery
recurrent laryngeal nerve (hoarseness)
superior laryngeal nerve (soft,
deep voice)
parathyroid glands
(hypocalcemia)
how to deterimine if thyroid nodule is adenoma vs carcinoma
capsular invasion
hypo vs hyper Ca symptoms
Hypocalcemia sx: neuromuscular irritability (tingling, tetany), prolonged QT, arrhythmias
Hypercalcemia sx: stones (kidney), bones (bone pain, osteitis fibrosa cystica), groans (peptic ulcers, pancreatitis), psychic overtones (depression, anxiety, ∆MS)
treatment for hypoparathyroidism
vit D + Ca replacement
what are Chvostek and trousseau signs
Chvostek sign: tapping on Cheek causes muscle contractions
Trousseau sign: inflating BP cuff causes carpal muscle spasms
what is pseudohypoparathyroidism?
dx? tx?
end-organ resistance to PTH → hypocalcemia sx
Dx ↑PTH, ↓Ca, ↑P
Tx vit D + calcium replacement
causes of primary hyperPTHism
how to make dx? tx?
90% adenoma, 9% hyperplasia,
1% carcinoma
Dx ↑PTH, ↑Ca, ↓P + Cl:P ratio >33:1
Tx surgery
• adenoma → take it out,
• hyperplasia → 3½ gland removal
• carcinoma → en bloc resection of parathyroid and ipsi thyroid lobe)
cause of 2/2 hyperPTHism
how to make dx? tx?
renal failure → ↓1α-hydroxylase → ↓vit D → ↓Ca → compensatory ↑PTH
Dx ↑↑PTH, ↓Ca, ↑P
* diff from 1/1 bc has inc in P
tx vit D + Ca replacemnt and low P diet
cause of 3/3 hyperPTHism
how to make dx? tx?
2° HPTH pts get renal txp but parathyroid glands still hypersecretory despite ↑Ca
Dx ↑PTH, ↑Ca, ↓P
**looks like 1/1 now
Tx observation for 1 year, then 3½ gland excision if still problematic
Ca level for hyperCa crisis
tx?
> 15
Tx “flush and drain” (NS then Lasix), then treat underlying cause
