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Flashcards in Masters of Surgery Deck (27):
1

Side effect of carbimazole and propylthiouracil?

Agranulocytosis (massive decrease in WBC)

2

What should you give people before thyroidectomy for hyperthyroidism?

Lugols iodine (potassium iodide) (reduces vascularity of gland)
Beta-blocker to block the cardiovascular and CNS symptoms of the thyrotoxicosis

3

Complications of thyroidectomy surgery

Haemorrhage (can cause respiratory distress by tracheal compression)
Hypocalcemia (caused by damage to parathyroid glands)
Recurrent laryngeal nerve injury

4

Which fascia is the thyroid gland in?

The pretrachial fascia

5

Thyroglossal tract

Connects back of tongue to the thyroid gland

6

Key steps in evaulation of thyroid nodule or goitre?

Thyroid function tests (TSH, T3 and free T4)
Fine Needle Aspiration Cytology (FNAC):
-determines whether the follicular cells are benign, suspicious or malignant

Other useful tests:
-Thyroid ultrasound (cystic vs. nodule)
-Thyroid isotope scan --> useful if there is a solitary nodule and suppressed TSH, to look for a solitary toxic adenoma

7

Treatment of solitary thyroid nodule? (hint FNAC)

Treatment depends on FNAC result
If benign, the nodule can be left alone and repeat FNAC in 6-12 months
If FNAC is suspicious --> thyroid lobectomy is carried out as a quarter of these nodules are malignant
If FNAC is frankly malignant --> total thyroidectomy
If FNAC reveals a cyst:
small cyst (4cm) treated by thyroid lobectomy because of risk of malignancy

8

Papillary carcinoma

Most common and best prognosis
Disease spread to the lymph nodes and by direct invasion into the neck
Distant metastases are uncommon

9

Follicular carcinoma

Tumour develops later in life than papillary carcinoma
Spread mainly via the blood stream with distant metastases to bones, liver and brain

10

Medullary carcinoma

This is uncommon and develops from the calcitonin-secreting parafollicular cells
SOMETIME ASSOCIATED WITH TUMOURS IN THE PARATHYROID AND ADRENAL GLANDS --> MEN2

11

There may be a history of irradiation to the head and neck during childhood or a family history of thyroid carcinoma?

Thyroid cancer, shocker

12

Diagnosis of thyroid cancer

Thyroid function tests
FNAC
Chest radiograph (to look for pulmonary metastasis)

13

A high serum calcium level coupled with a low serum phosphate level is highly suggestive of what?

(primary) hyperparathyroidism

14

Parathyroid hormone effects on calcium and phosphate?

Mobilises calcium from bone
Reduced renal calcium excretion
Promotes renal phosphate excretion

15

Causes of primary hyperparathyroidism

Single parathyroid adenoma (most common: 85%)
Generalised parathyroid hyperplasia (15%)
Parathyroid carcinoma (1%)

16

Secondary hyperparathyroidism

This develops as a result of some of the complex metabolic changes associated with chronic renal failure, which tend to produce a low calcium level

17

Hypokalaemia and hypertension

Aldosteronism

18

This can present as a hypertensive crisis with sweating, palpitations, severe headache and occasionally an MI or cerebrovascular incident?

Phaeochromocytoma

19

This can present insidiously with diastolic hypertension

Phaeochromoctyoma

20

Treatment of Phaechromocytoma

Usually, alpha-adrenergic blockade (phenoxybenzamine) is started some time before surgery, with agents such as nitroprusside and propanolol being used to control blodd pressure and heart rate during the operation

21

Questions you should ask when taking a thyroid history?

Family history of thyroid disease
Past medical history of neck irradiation
Any history of hoarseness

-ask the patient to swallow
-ask the patient to stick out his tongue

22

Most common cause of subperiostal bone resorption in the phalanges?

Hyperparathyroidism

23

Hot and cold thyroid nodules?

Hot nodules usually associated with hyperthyroidism
Cold nodules usually associated with malignancy (or simple cysts)

24

Type of thyroid cancer that usually metastasises to the bone?

Follicular

25

Hyperaldosteronism and renin levels?

Low renin in PRIMARY hyperaldosteronism
High renin in SECONDARY hyperaldosteronism (caused by hepatic or renal disease)

26

A patient with Cushing syndrome may be diabetic?

True
Glucose intolerance and fasting hyperglycemia are common in Cushing syndrome

27

Measuring urea and electrolyes (low potassium)
Increased plasma aldosterone
Decreased plasma renin

Primary hyperaldosteronism