thyrotropin-releasing hormone - released from hypothalamus - causes release of TSH

thyroid-stimulating hormone - released by anterior pituitary - causes release of thyroid hormone from the thyroid

Thyroid Gland Flashcards by Lauren Chorny

define the artery supply to the thyroid?

superior thyroid artery
- first branch of external carotid artery
inferior thyroid artery
- branch of the thyrocervical trunk

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what is the venous drainage of the thyroid?

superior thyroid vein
middle thyroid vein
inferior thyroid vein

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name the thyroid lobe appendage coursing toward the hyoid bone from around the thyroid isthmus?

pyramidal lobe

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name the lymph node group around the pyramidal thyroid lobe

delphian LN group

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what is the thyroid isthmus?

midline tissue border between the left and right thyroid lobes

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which ligament connects the thyroid to the trachea?

ligament of berry

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which paired nerves must be carefully identified during a thyroidectomy?

recurrent laryngeal nerves

found in the tracheoesophageal grooves and dive behind the cricothyroid muscle
damage to these nerves paralyzes laryngeal abductors and causes hoarseness if unilateral and airway obstruction if bilateral

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what other nerve is at risk during a thyroidectomy and what are the symptoms?

superior laryngeal nerve

- if damaged, patient will have a deeper and quieter voice

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What is TRH?

thyrotropin-releasing hormone

released from hypothalamus
causes release of TSH

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what is TSH?

thyroid-stimulating hormone

released by anterior pituitary
causes release of thyroid hormone from the thyroid

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what are the thyroid hormones?

T3 and T4

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what is the most active form of thyroid hormone?

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what is the negative feedback loop?

T3 and T4 feedback negatively on the anterior pituitary

- cause decreased release of TSH in response to TRH

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what do parafollicular cells secrete?

calcitonin

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what is the differential diagnosis of a thyroid nodule?

multi nodular goiter
adenoma
hyperfunctioning adenoma
cyst
thyroiditis
carcinoma/lymphoma
parathyroid carcinoma

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name three types of non thyroidal neck masses

inflammatory lesions: abscess, lymphadenitis
congenital lesions: thyroglossal duct, branchial cleft cyst
malignant lesions: lymphoma, metastases, squamous cell carcinoma

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what is the diagnostic test of choice for thyroid nodule?

FNA

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what in a history suggests thyroid carcinoma?

neck radiation
family history
young age
male>female

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what signs suggest thyroid carcinoma?

single nodule
cold nodule
increased calcitonin
lymphadenopathy
hard, immobile nodule

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what symptoms suggest thyroid carcinoma?

voice change (vocal cord paralysis)
dysphagia
discomfort
rapid enlargement

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what is the most common cause of thyroid enlargement?

multinodular goiter

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What is Plummer’s disease?

toxic multi nodular goiter

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what is the treatment of a patient with a history of radiation exposure, thyroid nodule, and negative FNA?

remove the nodule with thyroid lobectomy

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name the five main types of thyroid carcinoma

papillary carcinoma
follicular carcinoma
medullary carcinoma
Hürthle cell carcinoma
anaplastic/undifferentiated carcinoma

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what are the signs/symptoms of thyroid carcinoma?

mass/nodule, lymphadenopathy | - most are euthyroid

what is a papillary carcinoma's claim to fame?

most common thyroid cancer

what is the environmental risk of papillary adenocarcinoma?

radiation exposure

what are the associated histologic signs of papillary adenocarcinoma?

psammoma bodies - round microscopic calcific papillae lined by cells with clear, 'orphan Annie eye' nuclei and nuclear grooves

what postoperative medication should be administered for papillary adenocarcinoma?

thyroid hormone replacement, to suppress TSH

what is the most common site of metastases in papillary adenocarcinoma?

pulmonary (lungs)

describe the nodule consistent of follicular adenocarcinoma

rubbery, encapsulated

can the diagnosis of follicular adenocarcinoma be made by FNA?

no | - tissue structure is needed for a diagnosis of cancer

what histologic findings define malignancy in follicular adenocarcinoma?

capsular or blood vessel invasion

what is the most common site of distant metastasis in follicular adenocarcinoma?

bone

what is a Hürthle cell thyroid cancer?

thyroid cancer of the Hürthle cells

what is the cell of origin for Hürthle cell thyroid cancer?

follicular cells

how is the diagnosis made of Hürthle cell thyroid cancer?

FNA can identify cells, but malignancy can be determined only by tissue histology

what is the route of metastasis for Hürthle cell thyroid cancer?

lymphatic > hematogenous

what is the treatment of Hürthle cell thyroid cancer?

total thyroidectomy

with what other conditions is medullary thyroid carcinoma associated?

MEN-II | - Autosomal Dominant

what is the histology of medullary thyroid carcinoma?

amyloid stroma

what does medullary thyroid carcinoma secrete?

calcitonin

what is the appropriate stimulation test of medullary thyroid carcinoma?

pentagastrin | - causes an increase in calcitonin

describe the route of spread of medullary thyroid carcinoma

lymphatic and hematogenous to distant metastasis

how is the diagnosis of medullary thyroid carcinoma made?

FNA

what is the associated genetic mutation with medullary thyroid carcinoma?

RET proto-oncogene

if medullary thyroid carcinoma and pheochromocytoma are found, which one is operated on first?

pheochromocytoma

what is the treatment of medullary thyroid carcinoma?

total thyroidectomy and median LN dissection

what are the M's of medullary thyroid carcinoma?

MEN-II aMyloid Median LN dissection Modified neck dissection if lateral nodes are positive

what is anaplastic carcinoma also known as?

undifferentiated carcinoma

what are the associated histologic findings of anaplastic carcinoma?

giant cells, spindle cells

how is diagnosis of anaplastic carcinoma made?

FNA (large tumor)

what is the major differential diagnosis of anaplastic carcinoma?

thyroid lymphoma

what is the treatment of anaplastic carcinoma small tumors?

total thyroidectomy + XRT/chemotherapy

what is the treatment of anaplastic carcinoma with airway compromise?

debulking surgery and tracheostomy, XRT/chemotherapy

what lab value must be followed postoperatively after a thyroidectomy?

calcium

what is the differential diagnosis of postoperative dyspnea after a thyroidectomy?

neck hematoma | bilateral recurrent laryngeal nerve damage

what is the most common cause of hyperthyroidism?

Graves' disease

What is Graves' disease?

diffuse goiter with hyperthyroidism, exophthalmos, and pretibital myxedema

what is the etiology of Graves' disease?

caused by circulating antibodies that stimulate TSH receptors on follicular cells of the thyroid

what specific physical finding is associated with Graves'?

exophthalmos

how is the diagnosis of Graves' disease made?

increase T3, T4, and anti-TSH receptor antibodies | decreased TSH

name treatment option modalities for Graves' disease

medical blockade: iodide, propranolol, PTU, methimazole, potassium iodide radioiodide ablation: most popular surgical resection: bilateral subtotal thyroidectomy

what are the possible indications for surgical resection of Graves' disease?

suspicious nodule | if patient is noncompliant or refractory to medication, pregnant, a child, or if patient refuses radio iodide therapy

what is the major complication of radio iodide or surgery for Graves' disease?

hypothyroidism

what does PTU stand for?

propylthiouracil

how does PTU work?

inhibits incorporation of iodine into T4/T3 by blocking peroxidase oxidation of iodide to iodine inhibits peripheral conversion of T4 to T3

how does methimazole work?

inhibits incorporation of iodine into T4/T3 only

what is toxic multinodular goiter also known as?

Plummer's disease

what is toxic multinodular goiter?

multiple thyroid nodules with one or more nodules producing thyroid hormone - resulting in hyper functioning thyroid

what medication may bring on hyperthyroidism with a toxic multinodular goiter?

amiodarine

what is the treatment of toxic multinodular goiter?

surgically remove hyperfunctioning nodule(s)

what are the features of acute thyroiditis?

painful, swollen thyroid fever overlaying skin erythema dysphagia

what is the cause of acute thyroiditis?

bacteria (strep or staph) | - usually caused by thyroglossal fistula

what is the treatment of acute thyroiditis?

antibiotics, drainage of abscess, needle aspiration for culture, most patients need definitive surgery

what are the features of subacute thyroiditis?

glandular swelling, tenderness, often follows URI, elevated ESR

what is the cause of subacute thyroiditis?

viral infection

what is the treatment of subacute thyroiditis?

supportive | - NSAIDs, steroids

what is DeQuervain's thyroiditis?

another name for subacute thyroiditis

what are the two types of chronic thyroiditis?

Hashimoto's thyroiditis | Riedel's thyroiditis

what is the etiology of Hashimoto's disease

autoimmune

what is Riedel's thyroiditis?

bening inflammatory thyroid enlargement with fibrosis of thyroid - present with painless, large thyroid - fibrosis may involve surrounding tissues

what is the treatment for Riedel's thyroiditis?

surgical tracheal decompression' | thyroid hormone replacement PRN

Thyroid Gland Flashcards

(83 cards)