Lesson 1E (Part 3)

Question 1

Follicular neoplasm

Answer 1

Encapsulated true neoplasms of the thyroid gland

- 5-10% of all thyroid nodules

Question 2

What is differentiation of follicular adenoma from a follicular carcinoma based on?

Answer 2

The presence of capsular or vascular invasion on histologic examination
- cannot be made by sonography or by FNA cytology

Question 3

What does follicular adenomas and follicular carcinomas look like sonographically? (2)

Answer 3

1. Solitary encapsulated tumors

2. Well-defined peripheral hypoechoic halo representing the fibrous capsule

Question 4

What kind of follicular neoplasms are considered minimally invasive?

Answer 4

The types that are encapsulated

Question 5

What kind of follicular neoplasms are considered invasive?

Answer 5

Extends beyond the tumour capsule into blood vessels and adjacent parenchyma

Question 6

What is the echogenicity of follicular neoplasms?

Answer 6

Variable

• echogenic
• isoechoic
• hypoechoic

Question 7

How do echogenic adenomas appear?

Answer 7

1. Smoothly marginated
2. Ovoid in appearance
3. Pseudotesticle

Question 8

Medullary thyroid cancer

Answer 8

Neuroendocrine tumor arising from the parafollicular C cells located in the upper two thirds of the thyroid gland

Question 9

What is the sonographic appearance of medullary carcinoma? (3)

Answer 9

1. Solid
2. Hypoechoic
3. Coarse central calcifications

Question 10

Anaplastic carcinoma

Answer 10

Is a rare (<1%) thyroid mass that is extremely aggressive

Question 11

Who does anaplastic carcinoma affect?

Answer 11

The elderly with a history of goiter

Question 12

How does anaplastic carcinoma present?

Answer 12

A rapidly growing neck mass

- tumor invades locally

Question 13

How do anaplastic carcinomas appear sonographically? (6)

Answer 13

1. Large
   - at least 5 to 10 cm
2. Fixed
   - not going to move/slide
3. Hard
   - not compressible
4. Heterogeneous
5. Internal calcifications and cystic or necrotic areas
6. Adjacent enlarged lymph nodes

Question 14

What are most thyroid lymphomas?

Answer 14

Non-Hodgkin lymphomas

Question 15

How does lymphomas present itself?

Answer 15

With a rapidly enlarging painless neck mass

Question 16

What is the sonographic appearance of lymphoma? (2)

Answer 16

1. Very hypoechoic
2. Pseudocystic pattern
   - increased through transmission

Question 17

What is the sonographic appearance of metastatic disease? (5)

Answer 17

1. Nonspecific appearance
2. Usually solid
3. Noncalcified
4. Hypoechoic nodules
5. Can be hypervascular

Question 18

Hyperparathyroidism

Answer 18

Excess secretion of parathyroid hormone

- usually by benign tumours of a gland

Question 19

What does hyperparathyroidism cause?

Answer 19

The release of calcium from bones which raised the blood calcium levels
- hypercalcaemia

Question 20

What are 5 effects of hyperparathyroidism?

Answer 20

1. Polyuria and polydipsia
2. Formation of renal calculi
3. Anorexia and constipation
4. Muscle weakness
5. General fatigue

Question 21

What are the 2 types of hyperparathyroidism?

Answer 21

1. Primary

2. Secondary

Question 22

Primary hyperparathyroidism

Answer 22

An enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood
- hypercalcemia

Question 23

What is primary hyperparathyroidism caused by?

Answer 23

A single adenoma

- 85% of cases

Question 24

Primary

Answer 24

Is involved with the organ or system itself that is causing problems

Question 25

Secondary hyperparathyroidism

Answer 25

Occurs as a result of another disease that initially causes low levels of calcium in the body and over time, increased parathyroid hormone levels occur

Question 26

Secondary

Answer 26

Is involved with something outside the organ or system itself that is causing problems

Question 27

Tertiary hyperparathyroidism

Answer 27

Is a state of excessive secretion of parathyroid hormone after longstanding secondary hyperparathyroidism and resulting in hypercalcemia

Question 28

When does tertiary hyperparathyroidism persist?

Answer 28

After successful renal transplantation

Question 29

What are causes of hyperthyroidism? (6)

Answer 29

1. Medical conditions that cause low blood calcium levels or increased phosphate levels 2. Conditions that make it hard for the body to remove phosphate 3. Kidney failure 4. Not enough calcium in the diet 5. Vitamin D disorders 6. Problems absorbing nutrients from food

Question 30

What is the result of hyperparathyroidism? (4)

Answer 30

1. Increased risk of bone fractures 2. High blood pressure and heart disease 3. Kidney stones 4. Osteitis fibrosa

Question 31

Hypoparathyroidism

Answer 31

Parathyroid hormone deficiency that causes hypocalcaemia, due to abnormally low blood calcium levels

Question 32

Which parathyroid disorder is more common?

Answer 32

Hyperparathyroidism

Question 33

What does low levels of blood calcium cause? (5)

Answer 33

1. Tetany  2. Psychiatric disturbances 3. Paraesthesia 4. Grand mal seizures 5. In some cases, cataracts and brittle nails.

Question 34

What causes hypoparathyroidism? (3)

Answer 34

1. Damage to or removal of the glands during thyroidectomy 2. Ionising radiation development of autoantibodies to PTH and parathyroid cells 3. Congenital abnormality of the glands

Question 35

What is tetany caused by?

Answer 35

Hypocalcaemia

Question 36

Why is tetany caused by hypocalcaemia?

Answer 36

Because low blood calcium levels increase excitability of peripheral nerves

Question 37

Tetany

Answer 37

Very strong painful spasms of skeletal muscles, causing characteristic bending inwards of the hands, forearms and feet

Question 38

What us hypocalcaemia associated with?

Answer 38

Hypoparathyroidism

Question 39

Hypocalcaemia

Answer 39

Is a deficiency of vitamin D or dietary deficiency of calcium that results in chronic renal failure when there is excretion of excess calcium in the urine

Question 40

What does tetany affect?

Answer 40

The peripheral nerves