MBChB Surgery > Thyroid goiter > Flashcards

Thyroid goiter Flashcards

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1
Q

Define a thyroid goiter

A

Abnormal enlargement of the thyroid gland

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2
Q

Name common causes of thyroid goiter

A

Iodine deficiency
Autoimmune disorders
- Hashimotor’s
- Grave’s

Other

  • thyroid cyst
  • thyroid adenoma
  • thyroid carcinoma
  • ingestion of goitrogens
  • congenital
  • pituitary adenoma
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3
Q

Define a thyroid nodule

A

A discrete lesion within the thyroid gland that is radiologically distinct from the surrounding normal thyroid parenchyma

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4
Q

Name clinical features of hyperthyroidism

A
  1. Ocular
    - lid lag
    - lid retraction
    - Grave’s ophthalmopathy (exophthalmos, periorbital edema)
  2. Vocal
    - tremulous voice
  3. Dermatological
    - warm, moist skin
    - hyperhidrosis
    - pretibial myxedema
    - fine hair
    - diffuse hair loss
    - onycholysis
  4. Thyroid
    - diffuse smooth, non-tender goiter
    - audible bruit (Grave’s)
  5. Metabolic
    - heat intolerance
    - weakness
    - fatigue
    - weight loss
  6. CVS
    - tachycardia
    - palpitations
    - hypertension with widened pulse pressure
    - atrial fibrillation
    - chest pain
  7. MSK
    - hyperthyroid myopathy
    - osteopathy
  8. GIT
    - frequent bowel movements
  9. Reproductive
    - females (amenorrhoea, anovulation, dysfunctional uterine bleeding)
    - males (gynecomastia, libido issues, infertility ED)
  10. Neuropsychiatric
    - anxiety
    - restlessness
    - insomnia
    - tremors
    - hyperreflexia
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5
Q

Name symptoms of hypothyroidism

A
  1. Ocular
    - periorbital edema
  2. Vocal
    - hoarse voice
    - dysarthria
  3. Dermatological
    - cold, dry skin
    - hypohydrosis
    - coarse hair
    - hair loss
    - brittle nails
  4. Thyroid
    - goiter
    - atrophic
  5. Metabolic
    - cold intolerance
    - fatigue
    - weight gain
  6. CVS
    - bradycardia
    - myxedematous heart disease (dilated cardiomyopathy, dyspnea)
    - decreased CO
  7. MSK
    - hypothyroid myopathy
    - entrapment syndromes
    - myoedema
  8. GIT
    - constipation
  9. Reproductive
    - females (abnormal menstruation, galactorrhea)
    - males (ED, decreased libido, infertility)
  10. Neuropsychiatric
    - impaired cognition
    - depression
    - hyporeflexia
    - Woltman sign
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6
Q

Name important factors when taking a history in a thyroid goiter patient

A 
Age
Duration
Rapidity of growth
Family history
Personal history of RT
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7
Q

What is Berry sign?

A

Absence of distal carotid pulsation -> malignancy

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8
Q

What is Pemburton sign?

A

Bilateral arm elevation -> facial plethora

Indicates venous obstruction in goiter

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9
Q

Name lab findings in primary hyperthyroidism

A

TSH decrease

T3/4 increase

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10
Q

Name lab findings in secondary hyperthyroidism

A

TSH increase

T3/4 increase

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11
Q

Name lab findings in primary hypothyroidism

A

TSH increase

T3/4 decrease

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12
Q

Name lab findings in secondary hypothyroidism

A

TSH decrease

T3/4 decrease

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13
Q

Which thyroid diagnosis requires a radioisotope scan?

A

Primary hyperthyroidism

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14
Q

Name causes of increased uptake radioisotope scan

A

Grave’s
Autonomous nodule
Plummer’s disease

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15
Q

Name causes of normal uptake radioisotope scan

A

Thyroiditis
Drug-induced
Factitious

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16
Q

What kind of nodules can a radioisotope scan show?

A

Hot (hyperfunctioning)
Warm (iso-functioning)
Cold (non-functioning)

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17
Q

Which nodule has a risk of malignancy?

A

Cold nodule

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18
Q

Which serum test should be performed in suspected medullary thyroid cancer?

A

Serum calcitonin

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19
Q

Why should U/S be performed before biopsy?

A

To prevent distortion of the thyroid architecture

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20
Q

Which system is used to classify thyroid U/S findings?

A

TIRADS

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21
Q

Which system is used to report thyroid cytopathology?

A

Bethesda

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22
Q

Discuss the Bethesda system

A
  1. Unsatisfactory
  2. Benign
  3. Atypia/follicular lesion of undetermined significance
  4. Follicular neoplasm
  5. Suspicious for malignancy
  6. Malignancy
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23
Q

Name the 4 common types of thyroid cancer

A

Papillary
Follicular
Medullary
Anaplastic

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24
Q

Which is the most common thyroid cancer?

A

Papillary

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25
How does papillary thyroid carcinoma spread?
Lymphatically
26
How does follicular thyroid carcinoma spread?
Haematogenously
27
What is medullary carcinoma associated with?
MEN syndrome type 2A and type 2B
28
What is the average survival time in anaplastic thyroid carcinoma?
3-6m
29
Name complications of thyroid surgery
Recurrent laryngeal nn injury Ext br superior laryngeal nn injury Hypoparathyroidism Hemorrhage
30
Name indications for thyroid surgery
Compression symptoms Cosmetic Failed medical treatment Large retrosternal goiter
31
Give 2 reasons for post-thyroidectomy thyroid hormone replacement therapy
1. Prevents hypothyroidism | 2. Suppresses microscopic malignancy
32
Name adjuvant treatments for thyroid carcinoma
Radioactive iodine ablation | Suppression therapy
33
Which adjuvant therapy is used in medullary thyroid carcinoma?
EBRT | Intensity modulated RT
34
How do you F/U medullary carcinoma?
TSH Calcitonin CEA
35
What is the epidemiology of thyroid goiter?
F>M | Decreases with age
36
What is the weight of a normal adult thyroid gland?
20-30g
37
What is the volume of a normal adult thyroid gland?
7-10ml
38
What is the location of the thyroid gland?
Caudal to larynx surrounding the anterolateral part of the trachea
39
How can goiters be differentiated?
1. Morphology 2. Thyroid function 3. Dignity
40
How can goiters be classified according to morphology?
1. Diffuse | 2. Nodular
41
Name causes of a diffuse goiter
Grave's Hashimoto's Pituitary adenoma Iodine deficiency
42
Name causes of a nodular goiter
Cysts Adenoma Cancer
43
How can goiters be classified according to thyroid function?
Nontoxic Toxic Hypothyroid
44
Name causes of a nontoxic thyroid goiter
Iodine deficiency
45
Name causes of a toxic thyroid goiter
Grave's | Toxic multinodular
46
Name causes of a hypothyroid thyroid goiter
Hashimoto's | Congenital hypothyroid
47
Name clinical features of thyroid goiter
``` Asymptomatic Hyperthyroid symptoms Hypothyroid symptoms Obstructive symptoms LN enlargement Berry sign Pemberton sign Carotid bruit and palpable thrill (Grave's) ```
48
How can you diagnose a thyroid goiter?
1. Palpation 2. Bloods (TSH, antibodies, calcitonin) 3. Imaging (U/S, CT, MRI) 4. FNA
49
How is goiter classified by palpation?
0 - not palpable or visible 1 - palpable but not visible 2 - palpable and clearly visible
50
Name causes of primary hypothyroidism
``` Hashimoto's thyroiditis Iatrogenic Anti-thyroid medication - amiodarone - lithium Thyroiditis - silent thyroiditis - subacute granulomatous thyroiditis - postpartum thyroiditis ```
51
Name causes of secondary hypothyroidism
Pituitary adenoma Iatrogenic Infiltrative disease
52
Name causes of tertiary hypothyroidism
Hypothalamic disorders
53
Name causes of euthyroid sick syndrome
Severe illness | Severe physical stress
54
Name causes of primary hyperthyroidism
``` Grave's disease Toxic MNG Toxic adenoma Postpartum thyroiditis De Quervain thyroiditis ```
55
Name causes of secondary hyperthyroidism
Thyrotropic adenoma
56
What genetic factors are medullary carcinomas associated with?
RET gene mutation (MEN 2) | Familial medullary carcinoma
57
What genetic factors are papillary carcinomas associated with?
RET/PTC rearrangement | BRAF mutation
58
What genetic factors are follicular carcinomas associated with?
PAX8-PPAR-gamma rearrangement | RAS mutation
59
What genetic factors are anaplastic carcinomas associated with?
TP53 mutation
60
Name red flags for thyroid cancer
``` Male sex Age <14 or >70 RT history Family history (MEN2, thyroid, Gardner syndrome) Rapid growth Firm, fixed nodule Cervical lymphadenopathy ```
61
Name histological findings in papillary thyroid cancer
Psammoma bodies Orphan Annie eyes nuclei Nuclear grooves
62
Name histological findings in follicular thyroid cancer
Uniform follicles | Vascular/capsular invasion
63
Name histological findings in medullary thyroid cancer
``` Ovoid cells of C cell origin Stromal amyloid (Congo red stain) ```
64
Name histological findings in anaplastic thyroid cancer
Undifferentiated giant cells
65
Name indications for total thyroidectomy
Well-differentiated carcinoma Medullary carcinoma Resectable anaplastic
66
Name contraindications for hemithyroidectomy
Intrathyroidal tumour >4cm No extrathyroidal spread No distant/nodal metastasis No high-risk patient factors
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