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Section II General Surgery P203Surgical Recall Sixth > Thyroid Gland, C58 P438-452 > Flashcards

Thyroid Gland, C58 P438-452 Flashcards

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1
Q 
THYROID DISEASE
ANATOMY
Identify the following
structures:
P438 (picture)
A
  1. Pyramidal lobe
  2. Right lobe
  3. Isthmus
  4. Left lobe
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2
Q 
THYROID DISEASE
ANATOMY
Define the arterial blood
supply to the thyroid.
P438 (picture)
A

Two arteries:
1. Superior thyroid artery (first branch
of the external carotid artery)
2. Inferior thyroid artery (branch of
the thyrocervical trunk) (IMA
artery rare)

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3
Q 
THYROID DISEASE
ANATOMY
What is the venous drainage
of the thyroid?
P439 (picture)
A

Three veins:

1. Superior thyroid vein
2. Middle thyroid vein
3. Inferior thyroid vein
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4
Q 
THYROID DISEASE
ANATOMY
Name the thyroid lobe
appendage coursing toward
the hyoid bone from around
the thyroid isthmus.
P439
A

Pyramidal lobe

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5
Q 
THYROID DISEASE
ANATOMY
What percentage of patients
have a pyramidal lobe?
P439
A

≈50%

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6
Q 
THYROID DISEASE
ANATOMY
What veins do you first see
after opening the platysma
muscle when performing a
thyroidectomy?
P439
A

Anterior jugular veins

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7
Q 
THYROID DISEASE
ANATOMY
Name the lymph node
group around the pyramidal
thyroid lobe.
P439
A

Delphian lymph node group

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8
Q

THYROID DISEASE
ANATOMY
What is the thyroid isthmus?
P439

A

Midline tissue border between the left

and right thyroid lobes

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9
Q 
THYROID DISEASE
ANATOMY
Which ligament connects the
thyroid to the trachea?
P439
A

Ligament of Berry

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10
Q 
THYROID DISEASE
ANATOMY
What is the IMA (not I.M.A.)
artery?
P439
A

Small inferior artery to the thyroid from

the aorta or innominate artery

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11
Q 
THYROID DISEASE
ANATOMY
What percentage of patients
have an IMA artery?
P439
A

≈3%

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12
Q 
THYROID DISEASE
ANATOMY
Name the most posterior
extension of the lateral
thyroid lobes.
P440
A

Tubercle of Zuckerkandl

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13
Q 
THYROID DISEASE
ANATOMY
Which paired nerves must
be carefully identified
during a thyroidectomy?
P440
A 
Recurrent laryngeal nerves, which are
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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14
Q 
THYROID DISEASE
ANATOMY
What other nerve is at risk
during a thyroidectomy and
what are the symptoms?
P440
A

Superior laryngeal nerve; if damaged,
patient will have a deeper and quieter
voice (unable to hit high pitches)

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15
Q 
THYROID DISEASE
ANATOMY
What is the name of the
famous opera singer
whose superior laryngeal
nerve was injured during
thyroidectomy?
P440
A

Urban legend has it that it was Amelita
Galli-Curci, but no objective data support
such a claim (Ann Surg 233:588, April
2001)

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16
Q

THYROID DISEASE
PHYSIOLOGY
What is TRH?
P440

A

Thyrotropin-Releasing Hormone
released from the hypothalamus; causes
release of TSH

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17
Q

THYROID DISEASE
PHYSIOLOGY
What is TSH?
P440

A

Thyroid-Stimulating Hormone released
by the anterior pituitary; causes release of
thyroid hormone from the thyroid

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18
Q 
THYROID DISEASE
PHYSIOLOGY
What are the thyroid
hormones?
P440
A

T3 and T4

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19
Q 
THYROID DISEASE
PHYSIOLOGY
What is the most active form
of thyroid hormone?
P440
A

T3

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20
Q 
THYROID DISEASE
PHYSIOLOGY
What is a negative feedback
loop?
P440
A

T3 and T4 feed back negatively on the
anterior pituitary (causing decreased
release of TSH in response to TRH)

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21
Q 
THYROID DISEASE
PHYSIOLOGY
What is the most common
site of conversion of T4
to T3?
P440
A

Peripheral (e.g., liver)

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22
Q 
THYROID DISEASE
PHYSIOLOGY
What is Synthroid®
(levothyroxine): T3 or T4?
P441
A

T4

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23
Q 
THYROID DISEASE
PHYSIOLOGY
What is the half-life of
Synthroid® (levothyroxine)?
P441
A

7 days

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24
Q 
THYROID DISEASE
PHYSIOLOGY
What do parafollicular cells
secrete?
P441
A

Calcitonin

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25
``` THYROID DISEASE THYROID NODULE What percentage of people have a thyroid nodule? P441 ```
≈5%
26
``` THYROID DISEASE THYROID NODULE What is the differential diagnosis of a thyroid nodule? P441 ```
``` Multinodular goiter Adenoma Hyperfunctioning adenoma Cyst Thyroiditis Carcinoma/lymphoma Parathyroid carcinoma ```
27
``` THYROID DISEASE THYROID NODULE Name three types of nonthyroidal neck masses. P441 ```
``` 1. Inflammatory lesions (e.g., abscess, lymphadenitis) 2. Congenital lesions (i.e., thyroglossal duct [midline], branchial cleft cyst [lateral]) 3. Malignant lesions: lymphoma, metastases, squamous cell carcinoma ```
28
``` THYROID DISEASE THYROID NODULE What studies can be used to evaluate a thyroid nodule? P441 ```
U/S—solid or cystic nodule Fine Needle Aspirate (FNA) → cytology I scintiscan—hot or cold nodule
29
``` THYROID DISEASE THYROID NODULE What is the DIAGNOSTIC test of choice for thyroid nodule? P441 ```
FNA
30
``` THYROID DISEASE THYROID NODULE What is the percentage of false negative results on FNA for thyroid nodule? P441 ```
≈5%
31
``` THYROID DISEASE THYROID NODULE What is meant by a hot versus a cold nodule? P442 ```
``` Nodule uptake of IV 131I or 99mT Hot—Increased 123I uptake = functioning/ hyperfunctioning nodule Cold—Decreased 123I uptake  nonfunctioning nodule ```
32
``` THYROID DISEASE THYROID NODULE What are the indications for a I scintiscan? P442 ```
1. Nodule with multiple “nondiagnostic” FNAs with low TSH 2. Nodule with thyrotoxicosis and low TSH
33
``` THYROID DISEASE THYROID NODULE What is the role of thyroid suppression of a thyroid nodule? P442 ```
Diagnostic and therapeutic; administration of thyroid hormone suppresses TSH secretion, and up to half of the benign thyroid nodules will disappear!
34
``` THYROID DISEASE THYROID NODULE In evaluating a thyroid nodule, which of the following suggest thyroid carcinoma: History? P442 ```
1. Neck radiation 2. Family history (thyroid cancer, MEN-II) 3. Young age (especially children) 4. Male > female
35
``` THYROID DISEASE THYROID NODULE In evaluating a thyroid nodule, which of the following suggest thyroid carcinoma: Signs? P442 ```
1. Single nodule 2. Cold nodule 3. Increased calcitonin levels 4. Lymphadenopathy 5. Hard, immobile nodule
36
``` THYROID DISEASE THYROID NODULE In evaluating a thyroid nodule, which of the following suggest thyroid carcinoma: Symptoms? P442 ```
1. Voice change (vocal cord paralysis) 2. Dysphagia 3. Discomfort (in neck) 4. Rapid enlargement
37
``` THYROID DISEASE THYROID NODULE What is the most common cause of thyroid enlargement? P442 ```
Multinodular goiter
38
``` THYROID DISEASE THYROID NODULE What are indications for surgery with multinodular goiter? P442 ```
Cosmetic deformity, compressive | symptoms, cannot rule out cancer
39
THYROID DISEASE THYROID NODULE What is Plummer’s disease? P442
Toxic multinodular goiter
40
``` THYROID DISEASE MALIGNANT THYROID NODULES What percentage of cold thyroid nodules are malignant? P443 ```
≈25% in adults
41
``` THYROID DISEASE MALIGNANT THYROID NODULES What percentage of multinodular masses are malignant? P443 ```
≈1%
42
``` THYROID DISEASE MALIGNANT THYROID NODULES What is the treatment of a patient with a history of radiation exposure, thyroid nodule, and negative FNA? P443 ```
Most experts would remove the nodule surgically (because of the high risk of radiation)
43
``` THYROID DISEASE MALIGNANT THYROID NODULES What should be done with thyroid cyst aspirate? P443 ```
Send to cytopathology
44
``` THYROID DISEASE THYROID CARCINOMA Name the FIVE main types of thyroid carcinoma and their relative percentages. P443 ```
``` 1. Papillary carcinoma: 80% (Popular = Papillary) 2. Follicular carcinoma: 10% 3. Medullary carcinoma: 5% 4. Hürthle cell carcinoma: 4% 5. Anaplastic/undifferentiated carcinoma: 1% to 2% ```
45
``` THYROID DISEASE THYROID CARCINOMA What are the signs/ symptoms? P443 ```
Mass/nodule, lymphadenopathy; most are | euthyroid
46
``` THYROID DISEASE THYROID CARCINOMA What comprises the workup? P443 ```
FNA, thyroid U/S, TSH, calcium level, | CXR, +/-- scintiscan I
47
``` THYROID DISEASE THYROID CARCINOMA What oncogenes are associated with thyroid cancers? P443 ```
Ras gene family and RET proto-oncogene
48
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is papillary carcinoma’s claim to faim? P443 ```
Most common thyroid cancer (Think: Papillary = Popular) = 80% of all thyroid cancers
49
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the environmental risk? P443 ```
Radiation exposure
50
THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the average age? P444
30–40 years
51
THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the sex distribution? P444
Female > male; 2:1
52
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What are the associated histologic findings? P444 ```
``` Psammoma bodies (Remember, P = Psammoma = Papillary) ```
53
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA Describe the route and rate of spread. P444 ```
Most spread via lymphatics (cervical | adenopathy); spread occurs slowly
54
THYROID DISEASE PAPILLARY ADENOCARCINOMA uptake? P444
Good uptake
55
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the 10-year survival rate? P444 ```
≈95%
56
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the treatment for: <1.5 cm and no history of neck radiation exposure? P444 ```
Options: 1. Thyroid lobectomy and isthmectomy 2. Near-total thyroidectomy 3. Total thyroidectomy
57
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the treatment for: >1.5 cm, bilateral, cervical node metastasis OR a history of radiation exposure? P444 ```
Total thyroidectomy
58
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the treatment for: Lateral palpable cervical lymph nodes? P444 ```
Modified neck dissection (ipsilateral)
59
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the treatment for: Central? P444 ```
Central neck dissection
60
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA Do positive cervical nodes affect the prognosis? P444 ```
NO!
61
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is a “lateral aberrant thyroid” in papillary cancer? P444 ```
Misnomer—it is metastatic papillary | carcinoma to a lymph node
62
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What postoperative medication should be administered? P444 ```
Thyroid hormone replacement, to | suppress TSH
63
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is a postoperative treatment option for papillary carcinoma? P444 ```
Postoperative 131I scan can locate residual tumor and distant metastasis that can be treated with ablative doses of 131I
64
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What is the most common site of distant metastases? P445 ```
Pulmonary (lungs)
65
``` THYROID DISEASE PAPILLARY ADENOCARCINOMA What are the “P’s” of papillary thyroid cancer (7)? P445 ```
``` Papillary cancer: Popular (most common) Psammoma bodies Palpable lymph nodes (spreads most commonly by lymphatics, seen in ≈33% of patients) Positive 131I uptake Positive prognosis Postoperative 131I scan to diagnose/treat metastases Pulmonary metastases ```
66
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What percentage of thyroid cancers does it comprise? P445 ```
≈10%
67
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA Describe the nodule consistency. P445 ```
Rubbery, encapsulated
68
THYROID DISEASE FOLLICULAR ADENOCARCINOMA What is the route of spread? P445
Hematogenous, more aggressive than | papillary adenocarcinoma
69
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What is the male:female ratio? P445 ```
1:3
70
THYROID DISEASE FOLLICULAR ADENOCARCINOMA 131I uptake? P445
Good uptake
71
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What is the overall 10-year survival rate? P445 ```
≈85%
72
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA Can the diagnosis be made by FNA? P445 ```
No; tissue structure is needed for a | diagnosis of cancer
73
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What histologic findings define malignancy in follicular cancer? P445 ```
Capsular or blood vessel invasion
74
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What is the most common site of distant metastasis? P445 ```
Bone
75
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What is the treatment for follicular cancer? P445 ```
Total thyroidectomy
76
``` c What is the postoperative treatment option if malignant? P446 ```
Postoperative 131I scan for diagnosis/ | treatment
77
``` THYROID DISEASE FOLLICULAR ADENOCARCINOMA What are the 4 “F’s” of follicular cancer? P446 ```
``` Follicular cancer: Far-away metastasis (spreads hematogenously) Female (3 to 1 ratio) FNA . . . NOT (FNA CANNOT diagnose cancer) Favorable prognosis ```
78
THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is it? P446
Thyroid cancer of the Hürthle cells
79
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What percentage of thyroid cancers does it comprise? P446 ```
≈5%
80
THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the cell of origin? P446
Follicular cells
81
THYROID DISEASE HÜRTHLE CELL THYROID CANCER 131I uptake? P446
No uptake
82
THYROID DISEASE HÜRTHLE CELL THYROID CANCER How is the diagnosis made? P446
FNA can identify cells, but malignancy can be determined only by tissue histology (like follicular cancer)
83
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the route of metastasis? P446 ```
Lymphatic > hematogenous
84
THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the treatment? P446
Total thyroidectomy
85
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the 10-year survival rate? P446 ```
80%
86
``` THYROID DISEASE MEDULLARY CARCINOMA What percentage of all thyroid cancers does it comprise? P446 ```
≈5%
87
``` THYROID DISEASE MEDULLARY CARCINOMA With what other conditions is it associated? P446 ```
MEN type II; autosomal-dominant | genetic transmission
88
THYROID DISEASE MEDULLARY CARCINOMA Histology? P446
Amyloid (aMyloid = Medullary)
89
THYROID DISEASE MEDULLARY CARCINOMA What does it secrete? P446
Calcitonin (tumor marker)
90
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the appropriate stimulation test? P447 ```
Pentagastrin (causes an increase in | calcitonin)
91
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER Describe the route of spread. P447 ```
Lymphatic and hematogenous distant | metastasis
92
THYROID DISEASE HÜRTHLE CELL THYROID CANCER How is the diagnosis made? P447
FNA
93
THYROID DISEASE HÜRTHLE CELL THYROID CANCER 131I uptake? P447
Poor uptake
94
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the associated genetic mutation? P447 ```
RET proto-oncogene
95
THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the female/male ratio? P447
Female > male; 1.5:1
96
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the 10-year survival rate? P447 ```
80% without LN involvement | 45% with LN spread
97
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What should all patients with medullary thyroid cancer also be screened for? P447 ```
MEN II: pheochromocytoma, | hyperparathyroidism
98
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER If medullary thyroid carcinoma and pheochromocytoma are found, which one is operated on first? P447 ```
Pheochromocytoma
99
THYROID DISEASE HÜRTHLE CELL THYROID CANCER What is the treatment? P447
Total thyroidectomy and median lymph node dissection Modified neck dissection, if lateral cervical nodes are positive
100
``` THYROID DISEASE HÜRTHLE CELL THYROID CANCER What are the “M’s” of medullary carcinoma? P447 ```
``` Medullary cancer: MEN II aMyloid Median lymph node dissection Modified neck dissection if lateral nodes are positive ```
101
THYROID DISEASE ANAPLASTIC CARCINOMA What is it also known as? P447
Undifferentiated carcinoma
102
THYROID DISEASE ANAPLASTIC CARCINOMA What is it? P447
Undifferentiated cancer arising in ≈75% of previously differentiated thyroid cancers (most commonly, follicular carcinoma)
103
``` THYROID DISEASE ANAPLASTIC CARCINOMA What percentage of all thyroid cancers does it comprise? P448 ```
≈2%
104
``` THYROID DISEASE ANAPLASTIC CARCINOMA What is the gender preference? P448 ```
Women > men
105
``` THYROID DISEASE ANAPLASTIC CARCINOMA What are the associated histologic findings? P448 ```
Giant cells, spindle cells
106
THYROID DISEASE ANAPLASTIC CARCINOMA 131I uptake? P448
Very poor uptake
107
THYROID DISEASE ANAPLASTIC CARCINOMA How is the diagnosis made? P448
FNA (large tumor)
108
``` THYROID DISEASE ANAPLASTIC CARCINOMA What is the major differential diagnosis? P448 ```
``` Thyroid lymphoma (much better prognosis!) ```
109
``` THYROID DISEASE ANAPLASTIC CARCINOMA What is the treatment of the following disorders: Small tumors? P448 ```
Total thyroidectomy + XRT/chemotherapy
110
``` THYROID DISEASE ANAPLASTIC CARCINOMA What is the treatment of the following disorders: Airway compromise? P448 ```
Debulking surgery and tracheostomy, | XRT/chemotherapy
111
THYROID DISEASE ANAPLASTIC CARCINOMA What is the prognosis? P448
Dismal, because most patients are at stage IV at presentation (3% alive at 5 years)
112
``` THYROID DISEASE MISCELLANEOUS What laboratory value must be followed postoperatively after a thyroidectomy? P448 ```
``` Calcium decreased secondary to parathyroid damage; during lobectomy, the parathyroids must be spared and their blood supply protected; if blood supply is compromised intraoperatively, they can be autografted into the sternocleidomastoid muscle or forearm ```
113
``` THYROID DISEASE MISCELLANEOUS What is the differential diagnosis of postoperative dyspnea after a thyroidectomy? P448 ```
Neck hematoma (remove sutures and clot at the bedside) Bilateral recurrent laryngeal nerve damage
114
``` THYROID DISEASE MISCELLANEOUS What is a “lateral aberrant rest” of the thyroid? P448 ```
Misnomer: It is papillary cancer of a | lymph node from metastasis
115
``` THYROID DISEASE BENIGN THYROID DISEASE What is the most common cause of hyperthyroidism? P449 ```
Graves’ disease
116
THYROID DISEASE BENIGN THYROID DISEASE What is Graves’ disease? P449
Diffuse goiter with hyperthyroidism, | exophthalmos, and pretibial myxedema
117
THYROID DISEASE BENIGN THYROID DISEASE What is the etiology? P449
``` Caused by circulating antibodies that stimulate TSH receptors on follicular cells of the thyroid and cause deregulated production of thyroid hormones (i.e., hyperthyroidism) ```
118
``` THYROID DISEASE BENIGN THYROID DISEASE What is the female:male ratio? P449 ```
6:1
119
``` THYROID DISEASE BENIGN THYROID DISEASE What specific physical finding is associated with Graves’? P449 ```
Exophthalmos
120
THYROID DISEASE BENIGN THYROID DISEASE How is the diagnosis made? P449
Increased T3, T4, and anti-TSH receptor antibodies, decreased TSH, global uptake of 131I radionuclide
121
``` THYROID DISEASE BENIGN THYROID DISEASE Name treatment option modalities for Graves’ disease. P449 ```
``` 1. Medical blockade: iodide, propranolol, propylthiouracil (PTU), methimazole, Lugol’s solution (potassium iodide) 2. Radioiodide ablation: most popular therapy 3. Surgical resection (bilateral subtotal thyroidectomy) ```
122
``` THYROID DISEASE BENIGN THYROID DISEASE What are the possible indications for surgical resection? P449 ```
Suspicious nodule; if patient is noncompliant or refractory to medicines, pregnant, a child, or if patient refuses radioiodide therapy
123
``` THYROID DISEASE BENIGN THYROID DISEASE What is the major complication of radioiodide or surgery for Graves’ disease? P449 ```
Hypothyroidism
124
THYROID DISEASE BENIGN THYROID DISEASE What does PTU stand for? P449
PropylThioUracil
125
THYROID DISEASE BENIGN THYROID DISEASE How does PTU work? P450
``` 1. Inhibits incorporation of iodine into T4/T3 (by blocking peroxidase oxidation of iodide to iodine) 2. Inhibits peripheral conversion of T4 to T3 ```
126
``` THYROID DISEASE BENIGN THYROID DISEASE How does methimazole work? P450 ```
Inhibits incorporation of iodine into T4/T3 only (by blocking peroxidase oxidation of iodide to iodine)
127
THYROID DISEASE TOXIC MULTINODULAR GOITER What is it also known as? P450
Plummer’s disease
128
THYROID DISEASE TOXIC MULTINODULAR GOITER What is it? P450
Multiple thyroid nodules with one or more nodules producing thyroid hormone, resulting in hyperfunctioning thyroid (hyperthyroidism or a “toxic” thyroid state)
129
``` THYROID DISEASE TOXIC MULTINODULAR GOITER What medication may bring on hyperthyroidism with a multinodular goiter? P450 ```
Amiodarone (or any iodine-containing | medication/contrast)
130
``` THYROID DISEASE TOXIC MULTINODULAR GOITER How is the hyperfunctioning nodule(s) localized? P450 ```
131I radionuclide scan
131
THYROID DISEASE TOXIC MULTINODULAR GOITER What is the treatment? P450
Surgically remove hyperfunctioning nodule(s) with lobectomy or near total thyroidectomy
132
THYROID DISEASE TOXIC MULTINODULAR GOITER What is Pemberton’s sign? P450
Large goiter causes plethora of head with | raising of both arms
133
``` THYROID DISEASE THYROIDITIS What are the features of ACUTE thyroiditis? P450 ```
Painful, swollen thyroid; fever; overlying | skin erythema; dysphagia
134
``` THYROID DISEASE THYROIDITIS What is the cause of ACUTE thyroiditis? P450 ```
Bacteria (usually Streptococcus or Staphylococcus), usually caused by a thyroglossal fistula or anatomic variant
135
``` THYROID DISEASE THYROIDITIS What is the treatment of ACUTE thyroiditis? P450 ```
Antibiotics, drainage of abscess, needle aspiration for culture; most patients need definitive surgery later to remove the fistula
136
``` THYROID DISEASE THYROIDITIS What are the features of SUBACUTE thyroiditis? P451 ```
Glandular swelling, tenderness, often | follows URI, elevated ESR
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``` THYROID DISEASE THYROIDITIS What is the cause of SUBACUTE thyroiditis? P451 ```
Viral infection
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``` THYROID DISEASE THYROIDITIS What is the treatment of SUBACUTE thyroiditis? P451 ```
Supportive: NSAIDS,  ± steroids
139
``` THYROID DISEASE THYROIDITIS What is De Quervain’s thyroiditis? P451 ```
Just another name for SUBACUTE thyroiditis caused by a virus (Think: De QuerVain = Virus)
140
``` THYROID DISEASE THYROIDITIS How can the differences between etiologies of ACUTE and SUBACUTE thyroiditis be remembered? P451 ```
Alphabetically: A before S, B before V (i.e., Acute before Subacute and Bacterial before Viral and thus: Acute = Bacterial and Subacute = Viral)
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``` THYROID DISEASE THYROIDITIS What are the common causative bacteria in acute suppurative thyroiditis? P451 ```
Streptococcus or Staphylococcus
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``` THYROID DISEASE THYROIDITIS What are the two types of chronic thyroiditis? P451 ```
1. Hashimoto’s thyroiditis | 2. Riedel’s thyroiditis
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``` THYROID DISEASE THYROIDITIS What are the features of Hashimoto’s (chronic) thyroiditis? P451 ```
Firm and rubbery gland, 95% in women, | lymphocyte invasion
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``` THYROID DISEASE THYROIDITIS What is the claim to fame of Hashimoto’s disease? P451 ```
Most common cause of hypothyroidism | in the United States
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``` THYROID DISEASE THYROIDITIS What is the etiology of Hashimoto’s disease? P451 ```
Autoimmune (Think: HashimOTO = | AUTO; thus, Hashimoto = autoimmune)
146
``` THYROID DISEASE THYROIDITIS What lab tests should be performed to diagnose Hashimoto’s disease? P451 ```
Antithyroglobulin and microsomal | antibodies
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``` THYROID DISEASE THYROIDITIS What is the medical treatment for Hashimoto’s thyroiditis? P451 ```
Thyroid hormone replacement if hypothyroid (surgery is reserved for compressive symptoms and/or if cancer needs to be ruled out)
148
THYROID DISEASE THYROIDITIS What is Riedel’s thyroiditis? P452
Benign inflammatory thyroid enlargement with fibrosis of thyroid Patients present with painless, large thyroid Fibrosis may involve surrounding tissues
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``` THYROID DISEASE THYROIDITIS What is the treatment for Riedel’s thyroiditis? P452 ```
Surgical tracheal decompression, thyroid hormone replacement as needed— possibly steroids/tamoxifen if refractory

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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