Thyroid/Parathyroid

Question 1

mobile midline neck mass

Answer 1

thyroglossal duct cyst (remnant of thyroglossal duct)

Question 2

exophthalmos, thyroid

bruits, pretibial myxedema

Answer 2

hyperthyroid/graves

Question 3

pathophys of graves dz

Answer 3

disease (diffuse toxic
goiter): autoimmune dz due to
TSI (anti-TSH) → hyperthyroid

Question 4

diffuse toxic goiter is aka

Answer 4

graves dz

Question 5

treatment for hyperthyroid

Answer 5

PTU (pregnant)
methimazole (not pregnant)

oral radioiodine (can become hypothyroid)
subtotal thyroidectomy (permanent)

Question 6

what is plummer disease?

Dx? tx?

Answer 6

multiple hyperfunctioning areas in thyroid → hyperthyroid sx

Dx ↓TSH, ↑free T4 + patchy uptake on T3 scan

Tx oral radioiodine (2 cm)

Question 7

weakness, weight loss, atrial fibrillation

Answer 7

hyperthyroidism in the elderly

Question 8

↓TSH, ↑free T4 + hot nodule on T3 scan

tx?

Answer 8

Toxic adenoma: single hyperfunctioning nodule → hyperthyroid sx

Tx oral radioiodine (2 cm)

Question 9

marked fever, tachycardia, agitation, GI sx

tx? prognosis?

Answer 9

Thyroid storm

β-blockers + antithyroid drugs

20% mortality rate

Question 10

autoimmune dz w/ lymphocytic
infiltration → hypothyroid sx

tx?

Answer 10

Hashimoto thyroiditis:

synthroid

Question 11

Abs present in hashimotos

Answer 11

anti-TSH, antimicrosomal,
anti-thyroglobulin,
anti-peroxidase (TPO)

Question 12

painful granulomatous inflammation following viral URI → hypothyroid sx

tx?

Answer 12

Tx NSAIDs + observation (will self-resolve)

Question 13

painful, swollen, tender thyroid mass → hypothyroid sx

cause? tx?

Answer 13

Acute thyroiditis: will see ↑TSH, ↓/nl free T4
**due to Staph/Strep infx **

Tx: I&D

Question 14

firm, painless thyroid → hypothyroid sx

tx?

Answer 14

Riedel thyroiditis

tx: synthroid vs surgery

Question 15

marked hypothermia, ∆MS, respiratory depression

tx?

Answer 15

myxedema coma

Tx IV thyroxine + hydrocortisone + supportive care

Question 16

MC type of thyroid nodule?

Answer 16

benign colloid nodule

Question 17

signs that a thyroid nodule is likely malignant

Answer 17

-solid nodules
-cold nodules (lack of radioiodine
uptake)
-size >1.5 cm

Question 18

thyroid nodule + normal TSH, what is the next step?

Answer 18

FNA

Question 19

if the FNA of a thyroid nodule comes back indeterminate, what is the next step?

Answer 19

throid scn to determine if hot or cold,
hot = obsv
cold = surgery

Question 20

types of thyroid cancer in order of MC and LC

Answer 20

80% papillary, 15% follicular, 4% medullary, 1% anaplastic

Question 21

RF for developing thyroid cancer?

Answer 21

post radiation (papillary_ 
MEN2 (medullary)

Question 22

how does papillary vs follicuar vs medullary thyroid cancer spread?

Answer 22

papillary and meullary = lymphatic

follicular = hematogenous

Question 23

“Psamomma bodies w/ Orphan Annie nuclei”

Answer 23

papillary thryroid cancer

Question 24

throid nodule with amyloid deposits

Answer 24

medullary cancer

Question 25

follicualr thyroid cancer is MC seen

Answer 25

in paces with endemic iodine deficiency

Question 26

aggressive , lymphatic-spreading variant of follicular cancer

Answer 26

Hürthle cell cancer

Question 27

treatment for papillary vs follicuar vs medullary vs anaplastic thyroid cancer
+ what do you follow for reoccurance?

Answer 27

papillary: total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
• f/u thyroglobulin levels

follicular: hemilobectomy + frozen bx → totalthyroidectomy if bx shows carcinoma
• f/u thyroglobulin levels

medullary: total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
• f/u calcitonin levels + 24-hr urinary VMA (bc MEN2 w/ pheo)

anaplastic = palliative care

Question 28

How is px of thyroid cancer determined?

Answer 28

MACIS system –
Metastasis
Age (2 cm)

Question 29

complications of thyroid surgery

Answer 29

recurrent laryngeal nerve (hoarseness)

superior laryngeal nerve (soft,
deep voice)

parathyroid glands
(hypocalcemia)

Question 30

how to deterimine if thyroid nodule is adenoma vs carcinoma

Answer 30

capsular invasion

Question 31

hypo vs hyper Ca symptoms

Answer 31

Hypocalcemia sx: neuromuscular irritability (tingling, tetany), prolonged QT, arrhythmias

Hypercalcemia sx: stones (kidney), bones (bone pain, osteitis fibrosa cystica), groans (peptic ulcers, pancreatitis), psychic overtones (depression, anxiety, ∆MS)

Question 32

treatment for hypoparathyroidism

Answer 32

vit D + Ca replacement

Question 33

what are Chvostek and trousseau signs

Answer 33

Chvostek sign: tapping on Cheek causes muscle contractions

Trousseau sign: inflating BP cuff causes carpal muscle spasms

Question 34

what is pseudohypoparathyroidism?

dx? tx?

Answer 34

end-organ resistance to PTH → hypocalcemia sx

Dx ↑PTH, ↓Ca, ↑P

Tx vit D + calcium replacement

Question 35

causes of primary hyperPTHism

how to make dx? tx?

Answer 35

90% adenoma, 9% hyperplasia,
1% carcinoma

Dx ↑PTH, ↑Ca, ↓P + Cl:P ratio >33:1

Tx surgery
• adenoma → take it out,
• hyperplasia → 3½ gland removal
• carcinoma → en bloc resection of parathyroid and ipsi thyroid lobe)

Question 36

cause of 2/2 hyperPTHism

how to make dx? tx?

Answer 36

renal failure → ↓1α-hydroxylase → ↓vit D → ↓Ca → compensatory ↑PTH

Dx ↑↑PTH, ↓Ca, ↑P
* diff from 1/1 bc has inc in P

tx vit D + Ca replacemnt and low P diet

Question 37

cause of 3/3 hyperPTHism

how to make dx? tx?

Answer 37

2° HPTH pts get renal txp but parathyroid glands still hypersecretory despite ↑Ca

Dx ↑PTH, ↑Ca, ↓P
**looks like 1/1 now

Tx observation for 1 year, then 3½ gland excision if still problematic

Question 38

Ca level for hyperCa crisis

tx?

Answer 38

> 15

Tx “flush and drain” (NS then Lasix), then treat underlying cause