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ENDOC- THYROID Flashcards

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1
Q

Describe the anatomy of the thyroid.

A
  • Paired lobes of near-equal size (5 × 2 × 2 cm)
  • connected by isthmus
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2
Q

Describe the parenchyma of thyroid.

A

Parenchyma: Homogeneous with fine medium-level echogenicity greater than that of the muscle.

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3
Q

The thyroid’s anatomic landmarks are:

Midline

A

Anatomic landmarks:

  • : air-filled trachea which casts an air shadow
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4
Q

The thyroid’s anatomic landmarks are:

Lateral edge:______________

A

common carotid artery and internal jugular vein

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5
Q

The thyroid’s anatomic landmarks are:

Posteriorly:________________

A

longus colli muscles

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6
Q

The thyroid’s anatomic landmarks are:

Anteriorly:

A
  • sternohyoid,
  • sternothyroid,
  • and sternocleidomastoid muscles
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7
Q

connected across the trachea by a thin thyroid______________

A

isthmus

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8
Q

The thyroid lobes are often _______________ in size.

A

mildly asymmetric

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9
Q

The ______________-** commonly protrudes** from behind the trachea, nearly always on the left side, and must not be mistaken for a thyroid or parathyroid mass or lymph node (Fig.

A

esophagus

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10
Q
A
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11
Q

In the UTZ of the Thyroid, what probe is used and why?

A

We use the LINEAR PROBE

Because Linear probe is used only for superficial organs and Thyroid is an example.

NOTE: The CURVE probe is used for deep seated organs.

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12
Q

What is the ◦First choice and the most sensitive imaging modality for thyroid?

A

§Ultrasound

Note : can give anatomical but not FUNCTIONAL

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13
Q

◦ provides excellent functional information about the thyroid gland
“Hot” or “Cold

A

Thyroid scintigraphy

Note: Can give FUNCTIONAL but less of ANATOMICAL incontrast with UTZ

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14
Q

In thyroid scintigraphy:

HOT :

A

DARKER

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15
Q

In thyroid scintigraphy,

COLD:

A

lighter

Nmemonics: Hot place: DARKER people

Cold place: Lighter People

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16
Q
A

Thyroid Hot and Cold Scintigraphy

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17
Q

Extremely common:
◦4% to 8% of adults have palpable nodules
◦10% to 41% have nodules on US examination
◦50% have nodules at autopsy.
Increase in frequency with age
** More common in women. **

A

Thyroid Nodules

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18
Q

How many percent of the adult have thyroid nodules?

A

4% to 8%

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19
Q

What gender is more common for Thyroid nodules?

A

Female

” Tandaan kasi baka dahil sa when going through pregnancy dba increase thyroid hormones.. baka lng.. link link hehe”

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20
Q

What are the parameters of Malignant Thyroid nodules?

A
  1. Iso- or HYPERechoic
  2. MACROcalcifications
  3. Regular border
  4. No infiltrative margins
  5. absent of abnormal cervical lymph nodes
  6. Periphery nodular vascularity
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21
Q

What are the parameters of malignant Thyroid nodules in UTZ?

A
  1. Hypoechoic
  2. Microcalcifications
  3. Border irregularity
  4. infiltrative margins
  5. abnormal cervical lymph nodes
  6. Increased intranodular vascularity
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22
Q

What are your BENIGN THYROID NODULES?

A

ØAdenomatous nodules
ØFollicular adenoma
ØThyroid cyst
ØHemorrhage

NMEMONICS: FATH

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23
Q

Thyroid cancer, on the other hand, affects only ____________ of the population.

Thyroid cancer is less than 1% of all cancer and is the cause of less than 0.5% of all cancer deaths.

Most thyroid cancers are slow growing and have low morbidity and mortality.

A

0.1%

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24
Q

The ratio of benign thyroid nodules to thyroid cancer can be estimated at as high as ____________-.

The challenge of imaging studies and clinical evaluation is to establish the likelihood of malignancy and to select out for surgery only those patients with thyroid malignancy.

A

500:1

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25
select out for surgery **only** those patients **with\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
** thyroid malignancy.**
26
* * Colloid nodules** * * Most common thyroid nodule.**
Adenomatous Nodules
27
Adenomatous Nodules result from the\_\_\_\_\_\_\_\_\_\_\_\_\_
Growths resulting from **cycles of hyperplasia and involution of thyroid tissue** Multiple and associated with diffuse enlargement of the thyroid gland.
28
What are the imaging finding of Adenomatous Nodules?
Imaging findings: **◦Isoechoic or hypoechoic** to **thyroid parenchyma** ◦May **show degenerative change**s with **prominent cystic components,** ***_necrosis, hemorrhage, and calcification_***
29
dominant nodule (between arrowheads) with **cystic change** (arrow) measuring **18 mm in greatest dimension.** This nodule meets the Society of Radiologists in Ultrasound criteria for **fine-needle aspiration (FNA).** US-guided FNA biopsy yielded a cytologic diagnosis of **“colloid nodul**e” indicating **visualization of benign thyroid cells and thyroid colloid.** Note th**e homogeneous pattern** of the **visualized normal thyroid parenchyma (Thy).**
30
Most common ***_benign neoplasm_*** Autonomous hyperfunctioning adenomas ◦Hyperthyroidism
Follicular Adenoma
31
What are the imaging finding of Follicular Adenoma?
Imaging findings: ◦Most are **solitary**, **solid,** and **well encapsulated.** ◦**Hypo**echoic, **hyper**echoic, or **iso**echoic to **thyroid parenchyma** ◦**Hyperfunctioning adenomas** = strikingly **hypervascular on Doppler US.** ◦Degenerative changes
32
Hyperfunctioning adenoma appears ___________ on Doppler UTZ
◦Hyperfunctioning adenomas = strikingly **hypervascular** on Doppler US.
33
cause no alteration of overall thyroid function. includ**e focal necrosis**, **hemorrhage,** **edema, infarction, fibros**is, and **calcification.** Differentiation from follicular carcinoma is difficult; therefore an **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** is commonly considered an **indication for surgical removal** and **histologic determination of the presence of cancer.**
**FNA cytologic diagnosis of follicular neoplasm**
34
Follicular Adenoma Dominant thyroid nodule (between cursors, x, +) with an irregular area of cystic change is evident (arrow). Because a **diagnosis of follicular carcinoma could not be excluded,** this **lesion was surgically removed**. No histologic evidence Differentiation from follicular carcinoma is difficult; therefore an FNA cytologic diagnosis of follicular neoplasm is commonly considered an indication for surgical removal and histologic determination of the presence of cancer.
35
Follicular Adenoma Showing hypervascularity
36
* Extremely rare, * **epithelial-lined**, * simple cysts. * **Cystic degeneration of an adenomatous nodule** **(“colloid cyst”)** or a follicular adenoma.
Thyroid Cyst
37
Colloid Cyst
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Comet Tail Artifact.** A **sharply defined cystic lesio**n within the **right thyroid lobe shows floating punctate echogenic foci with a tapering tail (arrow).** This **comet tail artifact** is characteristic of **inspissated colloid and a benign lesion.**
38
Colloid Cyst—Comet Tail Artifact. A sharply defined cystic lesion within the right thyroid lobe shows floating punctate echogenic foci with a tapering tail (arrow). This comet tail artifact is characteristic of inspissated colloid and a benign lesion.
39
This comet tail artifact is characteristic of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
inspissated colloid and a benign lesion.
40
May occur into an **adenomatous nodule** or **a follicular adenoma,** or **spontaneously into normal parenchyma**. Patients present with **sudden neck pain** and **subsequent swelling.**
Hemorrhage
41
Imaging Findings Of Hemorrhage in Ultrasound:
** hypo**echoic nodule with internal debris.
42
Ultrasound: hypoechoic nodule with internal debris.
43
Malignant Thyroid Nodules
§Papillary thyroid carcinoma §Follicular thyroid carcinoma §Medullary thyroid carcinoma §Anaplastic thyroid carcinoma §Others: §Lymphoma §Metastasis
44
Among the malignant thyroid nodules this is the most common and comprises 75- 80 %
§Papillary thyroid carcinoma
45
Follicular thyroid ca is %
10-20%
46
3-5 % of the malignant thyroid nodules is
Medullary thyroid ca
47
1-2% of malignant Thyroid nodules is
§Anaplastic thyroid carcinoma
48
least aggressive cancers in human. Female (4:1)
Papillary Thyroid Carcinoma
49
What is the imaging finding in Papillary Thyroid Ca
Imaging Findings: * ◦Nodules are **hypo**echoic and **commonly multiple.** * ◦Punctate internal calcifications **(Psammoma bodies,42%)** * ◦Characteristic **parenhymal microcalcifications without a discrete mass present.** * **◦Cervical nodes may contain similar calcifications. **
50
in papillary thyroid CA\_\_\_\_\_\_\_\_\_\_\_,42%) and highly indicative of malignancy
Psammoma bodies
51
The Papillary thyroid CA tumor spreads commonly to regional nodes, but rarely ____________ spreads to lung or bone**. Five-year survival is 95% to 99%.**
(2% to 3%)
52
Papillary Thyroid Carcinoma Papillary Carcinoma of the Thyroid—**Microcalcifications**. Longitudinal image reveals **a solid nodule containing numerous punctate nonshadowing echogenic foci characteristic of microcalcifications** associated with **papillary carcinoma indicative of malignancy**. Biopsy proved papillary carcinoma.
53
** characteristic of microcalcifications** associated with papillary carcinoma indicative of malignancy. Biopsy proved papillary carcinoma.
** solid nodule** containing **numerous punctate nonshadowing echogenic foci**
54
** Slow-growing malignancy** ** Blood vessels invasion = Characteristic!** Hematogenous spread to lung and bone. ** Male gender** and older age
Follicular Thyroid Carcinoma
55
What is the imaging finding of Follicular Thyroid CA?
◦Solitary, isoechoic, and ill defined. **◦Cystic areas, hemorrhage, and necrosis** Larger size, **lack of an echolucent halo**, **hypoechoic appearance**, and **absence of cystic change**
56
In Follicular Thyroid CA Clinical features that favor malignancy are \_\_\_\_\_\_\_\_\_\_\_\_. Five-year survival is about **65%.cal nodes is uncommon.**
male gender and older age
57
The **sonographic features of follicular carcinoma** F**eatures that favor carcinoma** over adenoma include
**larger size,** **lack of an echolucent halo**, **hypoechoic appearance,** and **absence of cystic change**
58
Microlcalcification of \> or =1 cm
Strongly consider US- guided FNA
59
Solid) almost entirely or with central calcification) \> or = 1.5 cm
Stongly consider US-guided FNA
60
Mixed solid and cystic or almost entirely cystic with a solid mural component \> or = 2 cm
Consider US- guided FNA
61
Substantial growth since prior US
ConsiderUS-guided FNA
62
Almost entirely cystic with none of the above and no substantial growth ( or no prior US)
US-guided FNA probably not necessary
63
Multiple nodules
Consider US-guided FNA of one or more of the nodule selected by criteria listed for solitary nodules
64

Diagnostic Imaging (6 decks)

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