Thyroid powerpoint reverse Flashcards by Harley Schemenauer

Thyroid gland length

4-6 cm

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Thyroid gland AP

2-3 cm

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Throid gland width

2 cm

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Isthmus diameter

4-6 mm

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Thyroid in relations with trachea

lateral

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Thyroid in relations with esophagus and cervical spine

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Thyroid in relations with IJV and carotid artery

medial

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Pyramidal Lobe

a normal variant extending superior to the isthmus May be seen in pediatric but usually atrophies in the adult present in 15 to 30% of thyroids

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Vascular Supply

right and left superior thyroid arteries and inferior thyroid arteries

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First branch off the ECA

right and left superior thyroid arteries

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Venous Drainage

superior and middle thyroid veins into the jugular vein and the inferior thyroid veins into the inominate vein

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Strap Muscles

thin sonolucent bands along the anterior surface of thyroid Sternohyoid Omohyoid Sternothyroid

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Sternocleidomastoid muscle location

anterolaterally to thyroid

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Common Carotid artery and internal jugular vein location

lateral to thyroid glands

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Longus collie muscle

Posterior to the thyroid wedge-shaped sonolucent structure adjacent to the cervical vertebrae

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Esophagus is usually hidden because of what

Trachea

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Minor neurovascular bundle location

posterior to thyroid

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Parathyroid location

posterior to thyroid

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Thyroid gland function

Endocrine gland T3 T4 CALCITONIN

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The production and releae of the thyroid hormones are under the control of

TSH

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What is TSH produced by

anterior pituitary gland which is located in the brain

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Calcitonin is important for

calcium metabolism

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Euthyroid

state in which the thyroid is producing the right amount of thyroid hormone

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When does hyperthroidism occur

increased production of T-3 and T-4

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Metabolic rate Body’s growth and development Heart and blood vessel functions Brain function Behavior

Hormones affects

Thyroid enlargement Increased metabolic rate Weight loss Nervousness

Hyperthyroidism results in

acute situation with uncontrolled hyperthyroidism, usually precipitated by infection or surgery

Thyroid Storm

of resulting hyperthermia, tachycardia, heart failure and delirium

Hyperthyroidism may be life threatening because

Hypoechoic with diffuse enlargement without palpable nodules Doppler shows increased vascularity (thyroid inferno)

Sonographic Appearance of hyperthyroidism

inflammation of thyroid causing swelling and tenderness due to infection

Diffuse thyroid disease (Thyroiditis)

caused by infection or autoimmune disorder

Diffuse thyroid disease (Thyroiditis) is caused by

enlarged and hypoechoic

Diffuse thyroid disease (Thyroiditis) sonographic appearance

usually viral diffuse enlargement tenderness/mild to severe transient hyperthyroidism

De Quervain’s (sub acute granulamatous)

goitrous from of autoimmune thyroiditis-(chronic) a. Most common form b. auto-immune- chronic inflammation c. diffuse enlargement possibly asymmetric d. painless/ may develop mild pain over time e. eventual hypothyroidism f. more prevalent in women

Hashimoto’s Thyroiditis

a. possibly hypoechoic/normal echo texture b. thick fibrous strands c. Color flow variable can be increased or decreased vascularity with color doppler

Hashimoto’s Thyroiditis Sonopgraphic appearance

decreased production of T-3 and T-4

Hypothroidism occurs when theres a

thyroid failure, or abnormalites of the pituitary gland or hypothalamus

Hypothyroidism may be caused by

thick skin,puffy face,course hair, husky voice

Hypothyroidsm for adults

decreased physical and mental growth

Hypothyroidsm for infants and children

increased TSH decreased T4/T3

Hypothyroidism with a normal functioning pituitary and hypothalmus

decreased TSH increased T4/T3

Hyperthyroidism with a normal functioning pituitary and hypothalmus

Differentiates between hyperfunctioning “hot”nodules and hypofuntioning “cold” nodules. “Cold” nodules have a higher risk of malignancy

Nuclear medicine

Palpable enlargement Abnormal thyroid hormone level (s) Palpable mass in neck/thyroid Swelling of the neck Asymmetry of neck Redness and/or tenderness

Indications for exam

homogenous with fine echogenicity

Normal gland is

most common abnormality, most common in females age 50-70 Appears as an enlarged, heterogenous

Multinodular goiter

benign, usually single tumors Appears as a well defined hypoechoic mass 50% will have a halo or ring surrounding

Follicular adenomas

due to low iodine intake Low T-3 and T-4 levels. More prevelant in females during puberty Uncommon in the US

Endemic goiter

autoimmune disorder which produces hyperthyoidism Protruding eyeballs, thickening of the skin on the feet Appears as a diffusely enlarged thyroid Increased color doppler due to overactivity of the gland

Graves Disease Hyperthyroidism

heterogenous gland, increased color flow “thyroid inferno”

Graves Disease: Sonographic appearance Hyperthyroidism

hypermetabolism, diffuse toxic goiter, exopthalamos

Graves Disease: Clinical Findings Hyperthyroidism

women over 30

Graves Disease: more common in what gender and age Hyperthyroidism

papillary, follicular, medullary

Malignant

may be isoechoic, hypoechoic, cystic or solid

Tumor characteristics

multiple nodules are present

Risk of malignancy decreases when

definitive diagnosis

FNA is necessary for

4 glands 2 superior 2 inferior

Parathyroid

PTH (parathormone) which maintains the proper calcium levels in the blood

Parathyroid secretes

congenital,benign cysts located within the midline of the neck superior to the thyroid gland near the hyoid bone Asymptomatic, although may become painful when inflammed

Thyroglossal duct cyst

benign congenital cysts found most often near the angle of the mandible

Branchial cleft cysts

Enlargement termed lymphadenopathy Greater than 1cm (Beth says 2cm) Can result from infections and malignancies May lose their normal hilar features and contain calcifications

Cervical Lymph nodes

Performed by Radiologist Guided by ultrasound Cells read by Pathologist Results to endocrinologist

Thyroid FNA’s

diffuse toxic hyperplasia (Graves Disease) Toxic Multinodular Goiter Toxic Adenoma makes up 99% of cases

Disorder associated with hyperthyroidism

Thyroid enlargement

Nontoxic Simple Goiter Clinical Findings

sometimes smooth, sometime nodular possible compressoin of surrounding tissue

Nontoxic Simple Goiter Sonographic Appearance

Thyroidism Hypothyroidism Neoplasm

Nontoxic Simple Goiter Differential Considerations

Thyroid Enlargment

Toxic Multinodular Goiter Clinical Findings

enlarged inhomogeneous gland can have focal scarring, focal ischemia, necrosis, and cyst formation

Toxic Multinodular Goiter Sonographic Appearance

Neoplasm Cyst

Toxic Multinodular Goiter Differential Consideration

Diffuse toxic goiter

Graves Disease Clinical Findings

Diffusely homogeneous and enlarge

Graves Disease Sonographic Findings

Neoplasm Ophthalmopathy Cutaneous manifestation Hyperthyroidism

Graves Disease Differential Consideration

swelling and tenderness of thyroid later hypthyroidism

Thyroidism Clinical Findings

homogeneous enlargement with nodularity later inhomogeneous

Thyroidism Sonographic Appearacne

Neoplasm

Thyroidism Differential Consideration

solitary nodule or multiple nodule

Cyst Clinical Findings

Anechoic areas, echogenic fluid, or moving fluid levels1

Cyst Sonographic Appearance

Toxic multinodular goiter

Cyst Differential Consideration

Usually euthyroid or hyperthyroid

Adenoma Clinical Findings

Compression of adjacent structure fibrous encapsulation ranges from anechoic to hyperechoic may have a halo

Adenoma Sonographic Appearance

Grave's Disease

Adenoma Differential Consideration