thyroid, parathyroid and adrenal glands

Question 1

benign thyroid enlargement

Answer 1

growth of the gland
compression of trachea and oesophagus
stridor and dysphagia
carotid artery can be posteriorly displaced

Question 2

malignant thyroid enlargement

Answer 2

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

Question 3

what are the types of thyroid cancer?

Answer 3

papillary
follicular
medullary 
anaplastic
lymphoma

Question 4

papillary thyroid cancer

Answer 4

young people
local spread
good prognosis

Question 5

follicular thyroid cancer

Answer 5

middle age
lung/bone spread
usually good prognosis

Question 6

medullary thyroid cancer

Answer 6

familial link
local spread and metastases
poor prognosis

Question 7

anaplastic thyroid cancer

Answer 7

aggressive cancer
local spread
very poor prognosis

Question 8

lymphoma of thyroid

Answer 8

variable

usually poor prognosis

Question 9

red flag symptoms for thyroid

Answer 9

rapid growth 
cough 
hoarse voice
stridor 
multiple enlarged cervical lymph nodes 
tethering of lump to surrounding structures

Question 10

treatments for thyroid cancer

Answer 10

thyroidectomy
radioiodine therapy
external beam radiotherapy
chemotherapy

Question 11

radioiodine therapy

Answer 11

cannot be given to children and those that work/live with children need to stay away as they are radioactive

Question 12

chemotherapy for thyroid cancer

Answer 12

for lymphoma only

Question 13

thyroid conditions

Answer 13

hyperthyroidism
hypothyroidism 
graves disease 
hashimoto thyroiditis 
goitre

Question 14

graves disease

Answer 14

exopthalmus due to antibodies attacking thyroid also attack eyes

Question 15

goitre

Answer 15

non-neoplastic non-inflammatory enlargement

can be due to iodine deficiency

Question 16

thyroidectomy

Answer 16

transverse/horizontal incision 2 fingers breadths above suprasternal notch
longitudinal incision once in the fascia
dividing fascia makes structures more mobile

Question 17

risks of thyroid surgery

Answer 17

hypothyroidism
hypocalcaemia 
airway obstruction 
recurrent laryngeal nerve injury 
general surgical risks

Question 18

risks of thyroid surgery: hypothyroidism

Answer 18

no/underactive thyroid tissue
symptoms typical of hypothyroidism
treat with daily levothyroxine

Question 19

risks of thyroid surgery: hypocalcaemia

Answer 19

due to trauma/devascularisation or accidental excision of parathyroid glands

Question 20

presentation of hypocalcaemia

Answer 20

acute = laryngeal stridor and airway obstruction
subacute = tingling lips/fingertips, carpopedal spasm, tetany, laryngospasm, seizures, QT prolongation and cardiac arrest

Question 21

treatment of hypocalcaemia

Answer 21

1g of calcium gluconate slowly

Question 22

risks of thyroid surgery: airway obstruction

Answer 22

caused by compressing hematoma or tracheomalacia
need to reopen to evacuate hematoma
re-intubation
consider awake fiberoptic intubation

Question 23

risks of thyroid surgery: recurrent laryngeal nerve injury

Answer 23

damage to nerve during excision
causes hoarseness
aphonia, stridor and airway obstruction

Question 24

what are the general surgical risks?

Answer 24

wound infection
seroma
scarring

Question 25

what is tracheolmalacia?

Answer 25

floppy trachea

Question 26

what are the types of hyperparathyroidism?

Answer 26

primary secondary tertiary

Question 27

primary hyperparathyroidism causes

Answer 27

parathyroid gland adenoma hyperplasia carcinoma

Question 28

blood tests for hyperparathyroidism

Answer 28

increased/normal PTH increased Ca2+ decreased phosphate

Question 29

secondary hyperparathyroidism causes

Answer 29

hypertrophy of glands in response to prolonged hypocalcaemia CKD vitamin D deficiency

Question 30

secondary hyperparathyroidism blood tests

Answer 30

raised PTH decreased calcium increased phosphate

Question 31

tertiary hyperparathyroidism causes

Answer 31

parathyroid hyperplasia after longstanding secondary hyperparathyroidism in renal disease

Question 32

blood tests in tertiary hyperparathyroidism

Answer 32

increased PTH increased calcium - maybe normal normal or low phosphate

Question 33

what does PTH do?

Answer 33

causes bones to release calcium | kidneys reduce calcium clearance and cause vitamin D activation which increases absorption of calcium in gut

Question 34

where are the parathyroid glands?

Answer 34

4 - 2 superior and 2 inferior on each side of the thyroid gland

Question 35

what are the risks of parathyroid surgery?

Answer 35

``` hypocalcemia bleeding in neck recurrent laryngeal nerve injury wound infection seroma ```

Question 36

bleeding in neck

Answer 36

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

Question 37

treatment for wound infection

Answer 37

antibiotics incision drainage

Question 38

what is a a seroma ?

Answer 38

fluid collections underneath skin at an incision site - feels like a fullness or swelling

Question 39

symptoms and treatment of seroma

Answer 39

can usually disappear within few weeks if minor | if large needs surgical drainage

Question 40

what are the areas of the adrenal gland?

Answer 40

zona glomerulosa zona fasiculata zona reticularis adrenal medulla

Question 41

zona glomerulosa

Answer 41

mineralocorticoids - aldosterone production

Question 42

zona fasciculata

Answer 42

produce glucocorticoids - cortisol

Question 43

zona reticularis

Answer 43

androgen production - dehydroepiandrosterone/DHEA

Question 44

adrenal medulla

Answer 44

produce stress hormones - adrenaline/noradrenaline

Question 45

what is a pheochromocytoma

Answer 45

high adrenaline/noradrenaline

Question 46

what is congenital adrenal hyperplasia?

Answer 46

21-hydroxylase deficiency

Question 47

what are the signs and symptoms of adrenal tumours?

Answer 47

- 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