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Thyroid gland Flashcards

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1
Q

Function of the thyroid gland

A
  • Maintains body metabolism
  • Maintains growth
  • Maintains development
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2
Q

Why are ultrsound the most sensitive modality to evaluate the thyroid gland

A
  • It can detect thyroid lesions
  • it can accurately calculate the dimensions of the thyroid gland
  • It can identify the structures and vascularity
  • It evaluates diffuse changes to the thyroid parenchyma
  • Helps to differentiate between thyroid nodules, and cervical masses
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3
Q

Where is the thyroid located

A

Anteroinferior at the level of the thyroid cartilage

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4
Q

How many lobes in the thyroid

A

Two

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5
Q

What connects the two lobes of the thyroid

A

Isthmus

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6
Q

What are the anterior muscles at the thyroid

A

Strap muscles and sternocleidomastoid muscle

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7
Q

What are the three strap muscles

A
  1. Sternohyoid muscle
  2. Omohyoid muscle
  3. Sternothyroid muscle
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8
Q

What are the posterior structures of the thyroid and neck

A
  1. CCA
  2. JV
  3. Vagus nerve
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9
Q

What is the normal length of the thyroid in an adult

A

4 - 6 cm

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10
Q

What is the normal height of the thyroid gland in adult

A

1.3 - 1.8 cm

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11
Q

What is the normal width of thyroid gland in adult

A

1.5 - 2.0 cm

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12
Q

What is the normal length of the thyroid in children

A

2 -3 cm

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13
Q

What is the normal height of thyroid gland in children

A

0.2 -1.2 cm

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14
Q

What is the normal width of the thyroid gland in children

A

1.0 - 1.5 cm

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15
Q

What is the length, height and widht measurement of the parathyroid in an adult

A

5-7 mm
1-2 mm
3-4 mm

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16
Q

What are the three hormones released by thyroid

A
  1. Triidothyronine (T3)
  2. Thyroxine (T4)
  3. Calcitonin
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17
Q

The pathway of the hormones

A
  1. Hypothalamus releases thyrotropin releasing hormone
  2. TRH triggers pituitary gland to release thyroid stimulating hormone
  3. TSH Stimulates the thyroid to release T3 and T4
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18
Q

What gland secretes parathyroid hormone

A

Parathyroid gland

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19
Q

What is the function of the parathyroid hormone

A

Maintains homeostasis of blood calcium concentration by promoting calcium absorption into the blood preventing hypoglycemia.

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20
Q

Why a thyroid ultrasound

A

When there is a palpable thyroid nodules or multinodular goiter
Patient that are of high risk for thyroid malignancy due to radiation exposure and who are in their reproductive years.
In women between ages of 40-44 and in men between ages of 70- 74. Patients with palpable cervical adenopathy suspicious of malignancy

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21
Q

What should you look for in a thyroid ultrasound

A

If the mass is palpable
If the mass is within o4 adjacent to the thyroid
If the tumor is confined to the thyroid
Is the cervical lymphnodes involved
After operation is there residual or recurrent tumor in the thyroid bed or is there metastases to the lymphnodes in the neck.

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22
Q

What is the normal appearance of the thyroid on ultrasound

A

Uniformly

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23
Q

What are variants of the thyroid gland

A

Pyramidal lobe
Absence of isthmus
Assemetry
Absence of lateral lobes

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24
Q

The three composition of the nodule is

A

Solid
Cystic
Complex

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25
What is the echogenisty of the nodule
Hyperechoic Hypoechoic Isoechoic Markedly hypoechoic
26
How does the margins of the nodule appear
Well defined and regular Ill defined, blurred, irregular
27
What is the measurement of the nodule
Is it taller than wide
28
Malignant thyroid nodules
* Hyoechoic * Micro or interrupted rim calcification * Irregular margins * Absence of halo or incomplete halo * Increased intranodular flow * Height is greater than width * Significant increase in size over time * Invasion of anterior strap muscles * Presence of abnormal cervical lymphadenopath.
29
Benign thyroid lesions
* Pure cystic nodule * Hyperechoic * Halo sign or smooth margin * Spongiform nodule * Uninterrupted eggshell calcifications * Absent or peripheral vascularity. * Significant decrease in size over time * Multiple coalescent modules without normal intervening parenchyma * Normal small reactive cervical nodes
30
What is a goiter
It's the enlargement of the thyroid gland due to any cause
31
What are the two types of goiters
Toxic goiter Non toxic goiter
32
What is a toxic goiter
A hyperthyroid condition resulting from hyperactivity of the thyroid gland
33
What is a non toxic goiter
Diffuse thyroid enlargement not resulting of inflammation, neoplasm, hypo- or hyperthyroidism. The thyroid is enlarged but the thyroid levels are normal.
34
What are the sonographic findings of a goiter
* Isochoic compared to normal thyroid tissue * As it enlarges it becomes more isoechoic * A well defined halo surrounding nodules * There is colloid component of cystic elements * Focal scarring and ischemia, necrosis and cyst formation * Fibrosis or calcifications
35
What is hyperplasia
The enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells.
36
Thyroid hyperplasia
Caused by an iodine deficiency. Results from anything that lessons the intrthyroidal iodine levels
37
The sonographic finding of a cyst in thyroid
Purely anechoic areas containg serous or colloid fluid
38
What is an adenoma in thyroid
A benign thyroid neoplasm that is characterized by complete fibrous encapsulation
39
What are the sonographic features of a thyroid adenoma
* Peripheral halo that appears anechoic to completely hyperechoic * Predominantly cystic or mixed cystic and solid lesions * Isoechoic or predominantly anechoic * Homogenous or heterogenous * Increased peripheral blood flow patterns on colour doppler or within
40
What suggest malignancy in the thyroid
A solitary nodule with cervical adenopathy at the same side
41
What is the most common malignancy of the thyroid
Papillary carcinoma
42
What are the risk factors of papillary carcinoma
Females History of exposure to radiation in childhood Family history Obesity
43
What are the sonographic appearance of papillary carcinoma
* Hypoechoic lesion * Irregular outline * Microcalcifications ( small punctate hyperechoic foci) * Hypervascularity * Cervical lymphonode metastases
44
Follicular carcinoma
Second most frequent malignancy of the thyroid
45
What is the stage of invasiveness of an encapsulated follicular carcinoma
Minimally invasive
46
What is the stage of invasiveness of a non capsulated follicular carcinoma
Widely invasive as there can be invasion of the blood vessels
47
What organs does follicular carcinoma metastasis to
Bone Brain Lung Liver
48
What are the risk factors of follicular carcinoma
Females between ages of (40-60) Radiation exposure Iodine deficiency Pre existing thyroid disease
49
What are the sonographic findings of follicular carcinoma
Hypoechoic Irregular margins with thick irregular halo Nodular enlargement Tortuous internal blood flow
50
51
Modullary carcinoma
A familial neoplasm derived from parafollicular C cells and secretes calcium
52
What are the sonographic features of medullary carcinoma
Hypoechoic mass Calcium deposits Increased vascularity
53
Anaplastic thyroid carcinoma
A rare aggressive thyroid cancer composed of undifferentiated follicular cells with epitheloid and or spindle cell features
54
Risk factors of anaplastic carcinoma
Elderly patients Usually above 50 years
55
What are the sonographic findings of anaplastic carcinoma
Large hypoechoic mass Ill defined Calcifications Invasion of surrounding soft tissue and vessels
56
Thyroid lymphoma
Non Hodgkins type Presents as a rapidly growing painless mass
57
What are the symptoms of thyroid lymphoma
Obstructive symptoms such as Dyspnea Dysphasia
58
What are the risk factors of lymphoma
Females older than 60 History of chronic lymphocytic disease Subclinical or overt hypothyroidism
59
What are the sonogrphic features of thyroid lymphoma
Hypoechoic Lobulated/ nodular mass Non vascular Ill defined Heterogenous Large areas of cystic necrosis Encasement of adjacent vessels
60
What is acute supportive thyroiditis
A rare inflammatory disease caused by a bacterial infection in immunocompramised patients and children
61
The presentation of acute supportive thyroiditis
Pain Firmness Tenderness Redness Swelling Fever Dysphagia Difficulty moving neck
62
Ultrasound features of acute supportive thyroiditis
Perithyroidial soft tissue involvement Increased vascularity Heterogenous ecotecture Lymphnodes Hypoechoic Absess formstion
63
What is subacute granulomatous thyroiditis (de Quervains disease)
A spontaneously remitting inflammatory disease following a viral infection such as hepatitis B/C, mumps, cytomegalovirus, adenonvirus, measels, influenza
64
What is the presentation of De Quervains disease
Painful swelling in lower neck Fever Lethargy Gradually/ fairly abrupt onset of pain Can cause transient hypothyroidism
65
Sonographic features of deep Quervain disease
Hypoechoic mass Ill defined mass Decreased vascularity Sometimes involvement of contralateral lobes
66
What is chronic lymphocytic thyroiditis (Hashimotos disease)
The most common thyroiditis that is characterized by a destructive autoimmune disorder which leads to chronic inflammation of the thyroid
67
How does Hashimotos disease present
Painless Diffusely enlarged gland Young middle age females
68
Sonographic features of Hashimotos disease
Acute phase Small hypoechoic nodules Ill defined margins Origin in anterior portion of isthmus and thyroid
69
Sonographic features of Hashimotos disease
Subacute Infiltration proceeds to whole gland Hypervascular
70
Sonographic features of Hashimotos disease
Chronic Enlarged Slightly Lobulated / lobular outline Atrophied gland small
71
What is Graves disease
An autoimmune disorder caused by hyperthyroidism
72
Risk factors of Graves disease
Females over 30
73
What are the characteristics of Graves disease
Thyrotoxicosis Hypermetabolism Diffuse toxic goiter Exophthalmus Cutaneous manifistations Hyperthyroidism
74
What are the sonographic features of Graves disease
Enlarged Hypoechoic Inhomogenous Hypervascularity
75
What is the function of the parathyroid gland
Calsium sensing organ
76
What happens when there is a decrease in the serum calcium levels
A decrease or drop in the serum calsiumn levels Stimulates the parathyroid gland to secrete parathyroid hormone. The parathyroid hormone acts one the bone, kidneys and instine to enhance calcium absorption.
77
What transducer is used to scan the thyroid and parathyroid
High frequency transducer (7.5 -15 Mhz)
78
What is primary hyperparathyroidism
A condition where there is an increase function of the parathyroid gland, to much production of hormones that leads to a loss of bone tissue
79
Risk factors of primary hyperparathyroisdism
Women 2-3 times more likely to develop Hyperthyroidism
80
What are the characteristics of primary hyperparathyroisdism
Hypercalcemia Hypercalcuria Low serum levels of phosphate
81
What conditions causes primary parathyroidysm
Ademonas Primary hyperplasia Causes increase amount of pth
82
Parathyroid ademona
Benign tumor of parathyroid gland and most common cause of primary hyperparathyroisdism
83
Sonographic features of parathyroid adenoma
* Oval shape * Homogenous * Hypoechoic solid * Usually smaller than 3cm * Larger addnomas measure greater than 5 cm in length * Encapsulated with discrete border * Hypervascular
84
Parathyroid carcinoma
A rare small irregular mass.
85
What is important to the diagnostic process of parathyroid carcinoma
Metastases to the regional nodes, distant organs capsules invasion or local occurrence must be seen
86
What are the sonogrphic features of parathyroid carcinoma
Larger than ademona (>3cm) Lobular contour Heterogenous internal architecture Internal cystic components Absence of suspicious vascularity
87
What is secondary hyperparathyroisdism
Chronic hypercalcemia that is caused by renal failure, vitamin D deficiency (Rickets), or malabsorption syndromes.
88
What happens in secondary hyperparathyroisdism
The abnormalities induces PTH secretion that leads to hypercalcemia.
89
What are two examples of developmental cyst in the midline of the neck?
Thyroglossal duct cyst Brachial cleft cyst
90
What is a thyroglossal cyst
A congenital anomaly that appears at the midline of the neck anterior to the trachea.
91
What is a brachial c,eft cyst
A cystic formation usually located laterL to thyroid gland

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