Thyroid/Parathyroid 2

Question 1

causes of benign thyroid nodules

Answer 1

• Multinodular goiter
• Hashimoto’s thyroiditis
• Cysts
• Follicular adenomas

Question 2

causes of malignant thyroid nodules

Answer 2

CANCER

Question 3

higher concern of thyroid nodules in what scenarios?

Answer 3

– kids, men, adults <30 y/o & >60 y/o

–hx of head/neck radiation

–hx hematopoeitic stem cell transplant (HSC)

–family hx thyroid cancer

–Size > or equal to 2cm

Question 4

thyroid nodules approach

Answer 4

H&P

TSH

Thyroid US

Question 5

procedure of choice to evaluate thyroid nodules

Answer 5

FNA bx

Question 6

what size of thyroid nodule do you need multiple samples with?

Answer 6

Large nodules (>4 cm)

Question 7

what 2 ways can you do a FNA?

Answer 7

palpation or U/S guided

Question 8

General Indications for FNA

Answer 8

RECOMMENDED FOR THE FOLLOWING:

• High risk hX & > 5 mm
• Abnormal cervical lymph nodes
• Micro-calcifications: ≥ 1 cm

Question 9

indications for FNA Bx if solid nodule

Answer 9

Hypoechoic, > 1 cm

Iso- or hyperechoic, ≥ 1 to 1.5 cm

Question 10

indications for FNA Bx if mixed-cystic-solid thyroid nodule

Answer 10

w/ suspicious u/s: ≥ 1.5 to 2.0 cm

w/o suspicious u/s: ≥ 2.0 cm

Question 11

is a FNA bx recommended in a spongiform thyroid nodule?

Answer 11

if ≥ 2.0 cm, YES

Question 12

is a FNA Bx indicated for a purely cystic thyroid nodule?

Answer 12

NO

Question 13

mgmt of benign FNA

Answer 13

–Repeat U/S 6-18 months to assess stability

–Growth > 20% - repeat FNA

Question 14

thyroid CA is more common in (men/women)?

Answer 14

women

Question 15

what demographics have worse prognosis of thyroid carcinoma?

Answer 15

<20 age > 45 & Male sex

Question 16

RF of thyroid carcinoma

Answer 16

• Hx of childhood head or neck irradiation
• Thyroid cancer in first degree relative
• Large nodule size (≥ 4 cm)

Question 17

MC type of thyroid CA

Answer 17

papillary

Question 18

what type of thyroid CA has poor prognosis?

Answer 18

anaplastic

Question 19

which type of thyroid CA should you test for RET mutations as a genetic marker?

Answer 19

medullary

Question 20

Mets from what other sites could cause Thyroid CA?

Answer 20

Breast, colon, renal, melanoma

Question 21

tx for thyroid Carcinoma

Answer 21

• Surgery: Near total thyroidectomy
• TSH Suppression: Levothyroxine
• Radioiodine ablation
• Chemotherapy
• Palliative external radiotherapy

Question 22

thyroid carcinoma post-tx mgmt

Answer 22

–Serum thyroglobulin level, anti-thyroglobulin antibodies

–Neck ultrasound

–Serum TSH level

–MRI, CT, PET as appropriate

Question 23

function of parathyroid gland?

Answer 23

–Parathyroid hormone secretion to help regulate calcium homeostasis

–Also helps regulate phosphate

–Negative feedback with calcium sensing receptor on surface of

parathyroid cells

Question 24

MCC of hypoparathyroidism

Answer 24

acquired: usually occurs post-thyroidectomy

Question 25

Other causes of hypoparathyroidism

Answer 25

autoimmune congenital

Question 26

**•Tetany** •Muscle cramps **•Caropopedal spasm** •Irritability **•Altered mental status** * Convulsions * Stridor **•Paresthesias of circumoral area/hands/feet** **•Chvostek sign** **•Trousseau phenomenon** * Cataracts * Thin/brittle nails * Dry, scaly skin **•Candidiasis** •Loss of eyebrows **•Hyperactive DTRs** Clinical px of what?

Answer 26

hypoparathyroidism

Question 27

hypoparathyroidism dx

Answer 27

**low _Ca2+, urinary Ca2+, PTH, Mg_ (can be normal)** **high phosphate** **normal alk phos**

Question 28

hypoparathyroidism emergency tx

Answer 28

–**IV calcium gluconate** plus **oral calcitriol:** Wean to oral calcium –**Airway maintenance**

Question 29

hypoparathyroidism maintenance tx

Answer 29

–**Oral calcium and vitamin D** supplementation –**Avoid hypercalcemia** –2nd line tx: **recombinant hPTH**

Question 30

MCC of hyperparathyroidism

Answer 30

parathyroid adenoma

Question 31

cause of secondary or tertiary hyperparathyroidism

Answer 31

**Chronic renal failure:** Hyperphosphatemia and ↓renal vitamin D production → ↓ ionized calcium, which stimulates the parathyroids ## Footnote **Renal osteodystrophy**

Question 32

Asymptomatic hypercalcemia **“bones, stones, abdominal groans, and psychiatric moans”** clinical px of what?

Answer 32

hyperparathyroidism

Question 33

hyperparathyroidism dx

Answer 33

Elevated **calcium, serum PTH level** Urinary calcium excretion normal or elevated

Question 34

hyperparathyroidism tx

Answer 34

Surgical resection is definitive. **Parathyroidectomy** _**May be hypocalcemic post-op\*\*\***_

Question 35

hyperparathyroidism conservative tx

Answer 35

–Physical activity –Drink adequate fluids **–Avoid lithium and HCTZ** –Restrict **calcium intake to 1000 mg/day** –**Vitamin D 400-600 IU daily** –Monitor

Question 36

pharamcologic tx for prmary hyperparathyroidism

Answer 36

–**IV bisphosphonates** can temporarily ↓ hypercalcemia and treat bone painL **Zoledronic acid (Reclast)**

Question 37

pharmacologic tx for secondary or tertiary hyperparathyroidism

Answer 37

–**Cinacalcet** (Sensipar), **paricalcitol** (Zemplar)