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ABDOMEN 4 > 2.2 Thyroid-Benign/Malignancy > Flashcards

2.2 Thyroid-Benign/Malignancy Flashcards

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1
Q

Benign FOCAL thyroid disease includes (3)

A

Cysts
Thyroglossal Dust Cysts
Adenomas

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2
Q

True cysts are rare (that you’re born with)

Most cysts are caused by?

A

follicular adenoma (benign solid tumor) undergo degeneration and become more cystic in appearance.

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3
Q

These cysts can be due to blunt trauma or acute hemorrhage of adenoma

A

Hemorrhagic cysts

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4
Q

What types of cysts may you see (3)

Which one is unique to thyroid cysts?

A

Simple
Complex
Colloid (unique to thyroid) ** gelatinous material

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5
Q

What is the sonographic appearance of a colloid cyst

A

cystic lesion, single or multiple foci, with comet tail artifact.

can be large with multiple (many comet tail artifacts)

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6
Q

What is a congenital abnormality related to the thyroid gland?

A

Thyroglossal Duct cyst

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7
Q

Thyroglossal Duct cyst is located?

A

Midline neck, anterior to trachea, superior to isthmus

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8
Q

Why is a Thyroglossal Duct cyst formed?

A

Failure of tract to atrophy (base of tongue to isthmus)

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9
Q

Thyroglossal Duct cyst sonographically

A

Fusiform cystic structure less than 3 cm in size

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10
Q

What is a benign solid neoplasm with a capsule located in the neck?

A

Adenoma

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11
Q

WHAT IS THE MOST COMMON TYPE ADENOMA

A

Follicular Adenoma

can’t determined based on ultrasound

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12
Q

What are the features of adenomas (5)

A 
slow growing
variable in size
can compress adjacent tissue
Asymptomatic
Cold nodule on Nuc med scan
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13
Q

Sonographic feature of adenomas (6)

A 
Range of echogenicity (anechoic, iso, hyper)
Solitarty
Defined
Round/Oval
Hypoechoic halo
Eggshell calcification
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14
Q

What is an eggshell calcification?

A

calcs that surround periphery

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15
Q

WHAT ARE THE 2 Benign Diffuse Diseases?

A

Inflammation (thyroiditis)
Hyperplasia (goiter)

*Diagnosis based on clinical and lab findings

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16
Q

What is inflammation of the Thyroid and S&S?

A

Thyroiditits

Swelling, pain fever

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17
Q

The inflammatory conditions are most common in?

A

Middle aged women

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18
Q

WHAT ARE THE 5 FORMS OF THYROIDITIS

A
  1. Hashimoto’s (chronic lymphocytic)
  2. Acute Suppurative
  3. Subacute Granulomatous (De Quervain)
  4. Silent (painless)
  5. Invasive Fibrous (Reidels)
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19
Q

What is the most common form of ADULT hypothyroidism?

A

Hashimoto’s (chronic lymphocytic)***

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20
Q

Hashimotos is a inflammatory disease typically painless, more common in women and is an autoimmune disorder meaning it produces ?

A

Anti thyroid antibodies

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21
Q

Patients with a Hx of Hashimotos have an increased risk of developing ?

A

lymphoma of the thyroid gland

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22
Q

Hashimotos sonographically (5)

A

Diffusely enlarged, Heterogenous, Hypoechoic
Thyroid gland
Possible discrete calcs
Acute = hypervascular
But usually normal or decreased
Cervical lymphadenopathy (enlarged lymph nodes in the neck)

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23
Q

Hashimoto’s is difficult to differentiate from

A

MNG (multinodular goiter)

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24
Q

Rare thyroiditis more common in children?

A

Acute Suppurative Thyroiditis

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25
Describe Acute Suppurative Thyroiditis S & S | and What type of infection is it?
Firm PAINFUL thyroid Fever and Sore throat BACTERIAL INFECTION
26
Sonographically Acute Suppurative Thyroiditis (3)
Enlarges thyroid gland Hypoechoic Possible abscess (walled off collections of fluid and debris, looking like complex masses)
27
What is the thyroiditis where the glands swell rapidly and are very painful and tender
Subacute Granulomatous Thyroiditis
28
Subacute Granulomatous Thyroiditis other name?
De Quervain***
29
What type of infection is Subacute Granulomatous Thyroiditis
VIRAL INFECTION
30
The initial stages of Subacute Granulomatous Thyroiditis presents as
hyperthyroid | rarely progress to hypothyroid
31
Does Subacute Granulomatous Thyroiditis need surgery or will it go away on own?
remits spontaneously (goes away on own)
32
What is the sonographic appearance of Subacute Granulomatous Thyroiditis
Enlarged Hypoechoic Normally decreased vascularity
33
What is the thyroiditis that is enlarges with NO pain
Silent thyroiditis
34
Sonographically Silent thyroiditis resembles
Hashimotos
35
Clinically Silent thyroiditis resembles
Subacute granulomatous
36
What is the rarest form of thyroiditis?
Invasive Fibrous Thyroiditis
37
What is the other name for Invasive Fibrous Thyroiditis
Riedel's Struma
38
Invasive Fibrous Thyroiditis can result in ?
complete destruction of the thyroid gland
39
Sonographically Invasive Fibrous Thyroiditis
Enlarged Heterogeneous Can extend extrathyroid (into soft tissue surrounding thyroid gland)
40
Hyperplasia is known as a?
Goiter
41
Hyperplasia is described as ?
Diffuse enlargement +/- functional disturbances (hyper, hypo etc) Palpable gland
42
Causes of Hyperplasia (2)
Iodine deficiency | Defect in normal hormone synthesis
43
Does hyperplasia happen fast or slow
Slow, years to manifest
44
WHAT ARE THE 3 TYPES OF HYPERPLASIA (GOITER)
Grave's disease Nontoxic goiter Multinodular goiter
45
What is a diffuse toxic goiter (thyrotoxicosis) | means produces excess thyroid hormone (hyperthyroidism)
Grave's Disease
46
Is Graves Disease an autoimmune disorder?
Yes | body will produce thyroid antibodies
47
Is this condition common? | When it presents who do you see it in?
YES | more common in women 30-40 years of age
48
What are the signs and symptoms of Graves
Exophthalmos (bulging eyes) Skin thickening clubbed toes and fingers
49
Sonographically Graves disease appears as
``` Diffuse symmetrical enlargement Lobulated Homogeneous or heterogeneous Hypoechoic Color "thyroid inferno" Hyper-vascular ```
50
What hyperplasia (goiter) grows slowly and is due to lack of iodine
Non-Toxic Goiter
51
Non toxic goiter can be ____ or ____ and causes ___ functional disturbances
Endemic or Sporadic | No
52
Sonographically Non toxic goiter
Diffusely and uniformly enlarged | Smooth or nodular echo texture
53
What goiter is more common in females ages 50-70? with low iodine
Multinodular Goiter
54
What is larger the Multinodular goiter or the Non toxic goiter ?
Multinodular
55
Multinodular are
adenomas
56
low Iodine= thyroid hormone production. So thyroid release more ___ from pituitary, making thyroid gland enlarge and overtime develop____
TSH; nodules
57
Sonographically Multinodular Goiter
``` Enlarged thyroid gland Asymmetrical (MAKING THIS different) diffusely heterogeneous multiple discrete nodules Calcs Cystic areas Cold nodule ```
58
MALIGNANT LESIONS
------
59
Malignant lesions are more common in ____ ages ____
women; 40-60
60
Which are more worrisome, solitary or multiple nodules?
Solitary
61
Thyroid cancer is typically ___ growing
slow
62
__% of Nuc med cold nodules are malignant
20%
63
There is no sonographic feature that is sensitive enough to detect cancer of thyroid so what is needed?
FNA (fine needle aspiration)
64
Patients with thyroid cancer may present with (3)
Pressure symtoms - Swallow or breathing problems PAINLESS,palpable neck Hoarseness
65
What COULD be the sonographic appearance of malignancy in the thyroid? (6)
``` Hypoehcoic poorly defined jagged boarders absence of a halo (benign adenomas often have hypoechoic halo) microcalcs Taller than Wide (AP bigger than width) Enlarged nodes ```
66
Specific Thyroid Cancers include these (6)
``` Papillary Follicular Medullary Anaplastic Lymphoma Metastases ```
67
THE MOST COMMON AND LEAST AGGRESSIVE MALIGNANCY
PAPILLARY CARCINOMA* | 60-70%
68
Papillary are more common in females and are ___growing may spread to ______ and are _____.
Slow;Cervical lymph nodes; Asymptomatic
69
Sonographically Papillary Carcinoma (6)
``` Solid Hypoechoic mass (hypoechoic halo) May have micro calcs Mass can be tiny up to 10 cm Hypervascularity can have irregular boarders ```
70
What is the SECOND most common type of thyroid malignancy?
Follicular Carinoma* | 15-20%
71
Follicular carcinoma is still slow growing but more____ than Papillary
Aggressive | can metastases to bone via the blood
72
What is there a hx of with follicular carcinoma?
Radiation
73
What demographic is follicular carcinoma more common in, gender and age?
women | 40-50
74
Sonographically The Follicular carcinoma is similar to?
Benign adenoma
75
Therefore, what is the appearance of the follicular carcinoma?
Enlarged, encapsulating nodule BUT HAS irregular boarders thick halo microcalcs
76
This carcinoma is a hard bulky mass and only 5% of the carcinomas
Medullary Carcinoma
77
Medullary Carcinoma is more common in men or women?
BOTH equally (all other is more common in women)
78
Medullary Carcinoma secretes
secretes calcitonin (regulates blood calcium)
79
What is medullary carcinoma associated with
pheochromocytoma tumors (adrena gland)
80
What is the sonographic appearance of medullary carcinoma? (5)
``` Solid Hypoechoic Well-Circumscribed Encapsulated ****Coarse calcifications ```
81
What is the rarest and most aggressive carcinoma
Anaplastic Carcinoma
82
What patient age is Anaplastic most common in?
Older > 60 years
83
With Anaplastic carcinoma death often occurs from
Compression/asphyxiation | CCA, Jugular, Trachea, esophagus etc.
84
Sonographic appearance of Anaplastic carcinoma? (5)
``` Hypo solid Irregular Encase or invade blood vessels Invade neck muscles ```
85
PRIMARY _____ is most often ______
Lymphoma; Non-Hodgkins
86
Primary lymphoma is present more in older females and grows______
Rapidly
87
Primary lymphoma has a hx with
Hashimoto's
88
Primary lymphoma appears sonographically as
Hypo, lobular, non vascular
89
_____ to the thyroid gland is infrequent. If it does occur is occurs through _____ from____, ___,__ and __
Metastases hematogenous route, through the blood supply. from breast, lung colon or melanoma
90
About __% of pateints with systemic lymphoma have thyroid involvement.
20%
91
LIST BENIGN FEATURES of thyroid lesions
Regular, well defined boarders Thin, hypoechoic halo Solitary or multiple minute cysts within mass Hyperechoic Large calcs, especially around the periphery (eggshell)
92
LIST MALIGNANT FEATURES of thyroid lesions
Irregular boarders Absence of halo Microcalcs (other than meduallary carcinoma LARGE)
93
REVIEW QUESTIONS *may repeat
---------------
94
What is the most common thyroid carcinoma?
Papillary carcinoma (60-70%) most treatable
95
What is the most aggressive thyroid carcinoma
Anaplastic Carcinoma (invades other structures)
96
Which diffuse thyroid process causes hyperthyroidism?
Graves (toxic goiter)
97
What is the most common worldwide cause of multinodular goiter
Iodine deficiency

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