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ABS > Thyroid/Parathyroid > Flashcards

Thyroid/Parathyroid Flashcards

1
Q

What’s MEN1?

A

Pituitary neoplasm (unique)
Parathyroid hyperplasia
Pancreatic islet cell tumor (Unique)

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2
Q

What’s MEN2A?

A

Parathyroid hyperplasia
Medullary thyroid carcinoma
Adrenal pheochromocytoma

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3
Q

What’s MEN2B?

A

Medullary thyroid carcinoma
Adrenal pheochromocytoma
GI ganglioneuromatosis (Unique)
Marfanoid habitus (Unique)

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4
Q

What’s histologic finding of thyroid follicular cancer?
Papillary cancer?
Hurthle cell?
Medullary?
Anaplastic?

A

Follicular: solid sheets of cells that don’t contain colloids
Papillary: Psammoma bodies (large crowded nuclei with folded and grooved nuclear margins and intranuclear cytoplasmic inclusions)
Hurthle: Hypercellularity and eosinophilic cells
Medullary: Sheets of infiltrating neoplastic cells that are heterogenous in shape/size
Anaplastic: Spindle, polygonal, giant multinucleated cells with occasional foci of undifferentiated cells

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5
Q

Which thyroid cancer spreads hematogenously?

A

Folicular

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6
Q

What muscle does superior laryngeal nerve control and what happens w injury?
What muscle does recurrent laryngeal nerve control and what happens w injury?

A

SLN: Cricothyroid. Loss of pitch/projection/voice fatigbue
RLN: Rest of larynx including vocal cord. Hoarseness, airway obstruction w bilateral injury

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7
Q

What’s most common cause of thyroid storm? How do you treat it?

A

Post-op in undiagnosed Grave’s
B-Blocker followed by Lugol’s solution (KI), cooling blanket, O2, glucose

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8
Q

What’s indication for FNA on incidental thyroid nodules?

A

<1 cm: F/U w uiltrasound
1-1.5cm: FNA if suspicious (solid, hypoechogenic, microcalcification, intranodular vascularity, irregular/infiltrative margins, taller than wide)
>1.5cm: FNA

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9
Q

How do you prepare Grave’s pt for surgery?

A

Methimazole until euthyroid, then Lugol’s solution for 14 days, betablocker

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10
Q

How do you respond to FNA results? Follicular, Thyroid cancer, Cyst, Colloid, Normal with elevated TFT, Indeterminate

A

Follicular: lobectomy to further diagnose (10% ca risk)
Thyroid cancer: appropriate cancer tx
Cyst: drain fluid, if recurrent/bloody lobectomy
Colloid tissue: Thyroxine, lobectomy if enlarging
Normal tissue w ↑TFT: likely solitary toxic nodule, if symptomatic methimazole/131I
Indeterminate: Radionuclide study. If hot methimazole/131I, If cold lobectomy

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11
Q

What’s treatment for non-toxic goiter? What’s indication to operate?

A

Thyroxine. Airway compression or suspicious nodule, subtotal vs total for failure to medical tx.

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12
Q

How do you treat lingual thyroid gland?

A

2% malignancy risk, treat w thyroxine suppression/I131, resect if does not shrink

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13
Q

What’s mechanism of methimazole/PTU?

A

Peroxidase inhibitor

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14
Q

What’s side effects of methimazole?

A

Teratogen (cretinism), aplastic anemia, agranulosis

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15
Q

What’s side effect of PTU?

A

Hepatotoxicity, aplastic anemia, agranulosis

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16
Q

What’s contraindication to 131I?

A

Children and pregnancy

17
Q

What does FNA of hasimoto’s show?

A

Lymphocytic infiltrate

18
Q

What’s indication to operate on bacterial thyroiditis?

A

Rule out cancer for unilateral swelling and tenderness, persistent inflammation

19
Q

What causes De Quervain’s thyroiditis? How do you treat it?

A

Viral URI. Steroids and ASA

20
Q

What’s indication for total thyroidectomy in papillary thyroid cancer?

A

> 1cm, extra-thyroidal disease, multicentric/bilateral lesion, prior XRT

21
Q

What’s indication for modified radical neck dissection?

A

Extra-thyroidal disease

22
Q

What warrants completion thyroidectomy for follicular neoplasms?

A

Follicular cancer

23
Q

What’s indication for post-op radioactive iodine?

A

Papillary/follicular only: >1cm, extrathyroidal dz, recurrence, local invasion. Wait 6 weeks post-op without replacing thyroid so TSH is elevated which increase radioiodine uptake

24
Q

When do you do prophylactic throidectomy for MEN?

A

MEN2A: 6 yo
MEN2B: 2 yo

25
Q

What’s indication to operate on primary hyperPTH?

A

Symptomatic, CA>13, low Creatinine clearance, kidney stones, bone density T<-2.5, <50 yo

26
Q

What’s best time to do thyroidectomy in pregnancy? Parathyroid resection?

A

2nd trimester for both

27
Q

What’s expected PTH value after excision for parathyroid adenoma?

A

<1/2 preop value in 10 minutes

28
Q

What tumors should be treated first in MEN?

A

MEN1: parathyroid hyperplasia
MEN2a/b: Pheo

ABS (18 decks)

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