thyroid & parathyroid Flashcards
(80 cards)
FNA results on medullary thyroid carcinoma
amyloid deposits from calcitonin
True or false. Parathyroid carcinoma has a high rate of local recurrence
true
indications for surgical intervention for asymptomatic primary hyperparathyroidism:
age younger than 50
calcium level greater than 1 mg/dL above normal range
nephrolithiasis
osteoporosis with T score higher than -2.5 standard deviations from mean
compression fractures, nephrolithiasis, or nephrocalcinosis on imaging
urinary calcium >400micrograms per 24 hrs or high risk stone panel
Bethesda III
atypia of undetermined significance; repeat FNA or lobectomy
treatment of papillary thyroid cancer <4cm without nodal involvement or invasion and normal contralateral lobe:
thyroid lobectomy
true or false. lymph node dissection is necessary for papillary thyroid cancer even if there is no evidence of nodal involvement on imaging or exam
false
Miami criterion for parathyroid removal:
more than 50% drop in PTH level at 10 minutes following excision of suspected gland compared to teh highest pre-incision or pre-excision PTH level is predictive of surgical cure
if criterion not met at 10 minutes post excision, repeat at 20 minutes
if PTH still not decreased >50% at 20 min, the remaining parathyroids should be explored
treatment of a thyroid storm:
first give beta blockade
then methimazole to reduce production and release of thyroid hormone
give steroids to decrease peripheral conversion of T3 to T4 and decrease exophthalmos
true or false. nodules on thyroid ultrasound that are purely cystic do not require routine sonographic follow up when they are less than 1 cm
true
for patients with highest risk RET proto-oncogene mutation, thyroidectomy is recommended when?
at age 1 or time of diagnosis
treatment of parathyroid adenoma in the setting of MEN 1:
bilateral cervical exploration with resection of n3.5 glands and bilateral thymectomy; there is risk of supranumery glands and thymic carcinoids
true or false. a lesion less than 1 cm on thyroid US with benign features can be observed
true
treatment of hypercalcemic symptomatic patients:
hydration, bisphosphonates; loop diuretics have fallen out of favor
treatment of asymptomatic hypercalcemic patients:
calcitonin and bisphosphonates
best single place to stimulate with the nerve monitor to confirm a functional vocal cord at the end of neck surgery
ipsilateral vagus nerve
sonographic thyroid nodule features suspicious for malignancy:
solid hypoechoic nodule, irregular margins, microcalcifications, taller than wide shape, rim calcifications, extrathyroidal extension
you should bx suspicious thyroid nodules that are >___
1cm
sonographic thyroid nodule features that are not suspicious for malignancy/likely benign:
isoechoic or hyperechoic solid nodule; no irregular margins or calcifications; spongiform appearance
you should bx benign appearing thyroid nodules when they are >__
2cm
genetic disorder due to inactivating mutations in the calcium-sensing receptor of the parathyroids and kidneys
familial hypocalciuric hypercalcemia; benign condition, no treatment needed
lab findings of familial hypocalciuric hypercalcemia:
reduction in excretion of urinary calcium; can have mild hypercalcemia with “normal” or minimally elevated PTH
higher than normal serum calcium is required to reduce PTH release
a tumor marker for papillary thyroid cancer that can be used as a marker for disease recurrence
thyroglobulin
steps intraoperatively when facing a missing inferior parathyroid:
mobilize the thymus and resect it
if the glad is still missing, ligate the middle thyroid vein and divide to allow mobilization of the thyroid lobe and provide additional exposure
if gland still missing, the last step before aborting is lobectomy of the thyroid
true or false. papillary and follicular thyroid carcinoma <1cm can be managed with partial thyroidectomy
true
