thyroid, parathyroid and adrenal glands Flashcards
benign thyroid enlargement
growth of the gland
compression of trachea and oesophagus
stridor and dysphagia
carotid artery can be posteriorly displaced
malignant thyroid enlargement
erosion into oesophagus/trachea/carotid sheath
can cause severe haemorrhage
involvement of sympathetic chain = causes horner’s syndrome
invasion of recurrent laryngeal nerve causing hoarseness
what are the types of thyroid cancer?
papillary follicular medullary anaplastic lymphoma
papillary thyroid cancer
young people
local spread
good prognosis
follicular thyroid cancer
middle age
lung/bone spread
usually good prognosis
medullary thyroid cancer
familial link
local spread and metastases
poor prognosis
anaplastic thyroid cancer
aggressive cancer
local spread
very poor prognosis
lymphoma of thyroid
variable
usually poor prognosis
red flag symptoms for thyroid
rapid growth cough hoarse voice stridor multiple enlarged cervical lymph nodes tethering of lump to surrounding structures
treatments for thyroid cancer
thyroidectomy
radioiodine therapy
external beam radiotherapy
chemotherapy
radioiodine therapy
cannot be given to children and those that work/live with children need to stay away as they are radioactive
chemotherapy for thyroid cancer
for lymphoma only
thyroid conditions
hyperthyroidism hypothyroidism graves disease hashimoto thyroiditis goitre
graves disease
exopthalmus due to antibodies attacking thyroid also attack eyes
goitre
non-neoplastic non-inflammatory enlargement
can be due to iodine deficiency
thyroidectomy
transverse/horizontal incision 2 fingers breadths above suprasternal notch
longitudinal incision once in the fascia
dividing fascia makes structures more mobile
risks of thyroid surgery
hypothyroidism hypocalcaemia airway obstruction recurrent laryngeal nerve injury general surgical risks
risks of thyroid surgery: hypothyroidism
no/underactive thyroid tissue
symptoms typical of hypothyroidism
treat with daily levothyroxine
risks of thyroid surgery: hypocalcaemia
due to trauma/devascularisation or accidental excision of parathyroid glands
presentation of hypocalcaemia
acute = laryngeal stridor and airway obstruction subacute = tingling lips/fingertips, carpopedal spasm, tetany, laryngospasm, seizures, QT prolongation and cardiac arrest
treatment of hypocalcaemia
1g of calcium gluconate slowly
risks of thyroid surgery: airway obstruction
caused by compressing hematoma or tracheomalacia
need to reopen to evacuate hematoma
re-intubation
consider awake fiberoptic intubation
risks of thyroid surgery: recurrent laryngeal nerve injury
damage to nerve during excision
causes hoarseness
aphonia, stridor and airway obstruction
what are the general surgical risks?
wound infection
seroma
scarring
what is tracheolmalacia?
floppy trachea
what are the types of hyperparathyroidism?
primary
secondary
tertiary
primary hyperparathyroidism causes
parathyroid gland adenoma
hyperplasia
carcinoma
blood tests for hyperparathyroidism
increased/normal PTH
increased Ca2+
decreased phosphate
secondary hyperparathyroidism causes
hypertrophy of glands in response to prolonged hypocalcaemia
CKD
vitamin D deficiency
secondary hyperparathyroidism blood tests
raised PTH
decreased calcium
increased phosphate
tertiary hyperparathyroidism causes
parathyroid hyperplasia after longstanding secondary hyperparathyroidism in renal disease
blood tests in tertiary hyperparathyroidism
increased PTH
increased calcium - maybe normal
normal or low phosphate
what does PTH do?
causes bones to release calcium
kidneys reduce calcium clearance and cause vitamin D activation which increases absorption of calcium in gut
where are the parathyroid glands?
4 - 2 superior and 2 inferior on each side of the thyroid gland
what are the risks of parathyroid surgery?
hypocalcemia bleeding in neck recurrent laryngeal nerve injury wound infection seroma
bleeding in neck
can push on trachea causing difficulty breathing
patients should be wary of difficulty breathing, high squeaky voice, neck swelling and feeling something bad is happening
treatment for wound infection
antibiotics
incision
drainage
what is a a seroma ?
fluid collections underneath skin at an incision site - feels like a fullness or swelling
symptoms and treatment of seroma
can usually disappear within few weeks if minor
if large needs surgical drainage
what are the areas of the adrenal gland?
zona glomerulosa
zona fasiculata
zona reticularis
adrenal medulla
zona glomerulosa
mineralocorticoids - aldosterone production
zona fasciculata
produce glucocorticoids - cortisol
zona reticularis
androgen production - dehydroepiandrosterone/DHEA
adrenal medulla
produce stress hormones - adrenaline/noradrenaline
what is a pheochromocytoma
high adrenaline/noradrenaline
what is congenital adrenal hyperplasia?
21-hydroxylase deficiency
what are the signs and symptoms of adrenal tumours?
- high BP
- low potassium
- heart palpitations
- nervousness
- feelings of anxiety or panic attacks
- headaches
- excessive sweating
- diabetes
- abdominal pain
- unexplained weight gain or loss
- weakness
- abdominal stretch marks
- excessive hair growth
- changes in genitalia
- unusual acne
- change in libido
