Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
54 Cards in this Set
- Front
- Back
|
anatomic ways to classify goiters
|
diffuse
uninodular multinodular |
|
|
functional classification of goiter
|
euthyroid/non toxic
toxic nodular |
|
|
things that can cause a goiter
|
Iodine deficency
Excess IGF-1 Excess TSH |
|
|
definition of endemic goiter
|
when its prevelence in a geographic iodine deficicnt area is more than 10% in children or 5% of adults
|
|
|
cretinism arises when
|
fetus is exposued to low thyroid levels-- mental and growth retardation
|
|
|
what percentage of thyroid nodules are malignant?
|
5-8%
|
|
|
what percentage of thyroid nodules are toxic?
|
5-10%
|
|
|
what is the natural hx of thyroid nodules
|
15% incr in size over 10 yrs
-may initally cause subclinical hyperthyroidsm -may later cause over hyperthyroidsm |
|
|
what are the clinical manifestations of thyroid nodules?
|
usually asymptomatic
-compression sx: dyspnea, cough, dysphagia -hoarsness (suggests malignancy) -sudden pain -hyperthyroidism |
|
|
how is MEN2 related to thyroid cancer?
|
assoc with medullary thyroid cancer, pheochromocytoma, and hyperparathyrodism
|
|
|
most common types of thyroid cancer
|
papillary (75)
Follicular (15%) -Hurthle cell (3%) |
|
|
anaplastic thyroid cancer
|
-occurs in older individuals
-poor prognosis |
|
|
what are factors associated with malignant thyroid nodules
|
male gender
family hx lymphadenopathy horsenss exposure to radiation in head or neck rapid growth of nodule firm and fixed nodule age younger than 20 or older than 60 vocal cord paralysis |
|
|
what laboratory findings are impt in pts with nodules?
|
TSH levels to rule out toxic goiter
-calcitonin levels as a tumor marker before and after surgery for pts with medullary thryorid cancer |
|
|
what imaging studies can be used in pts with thyroid nodules?
|
scintigraphy (RAI-- radioactive iodine scan)
-CT scan -US -PET |
|
|
uses of US in examining thyroid nodules
|
-high morphologic resolution
-allow distinction btwn solic and cystic -distinguish benign vs malignant -guidance for FNB -estimate size |
|
|
hypoechoic areas on US are
|
darker
-could be cystic or cancerous |
|
|
gross finding of thyroid in graves
|
diffuse hypertrophy and hyperplasia
no nodules |
|
|
histological findings in graves diseases
|
scalloped follicles
lymphocytic infiltrates |
|
|
gross findings in hashimoto thyroiditis
|
diffuse and symmetrically enlarged thyroid
|
|
|
histological findings in haschimoto's thyroditis
|
-mononuclear inflammaory infiltrate
germinal centers Hurthle cells-- eosinophilic granular cyttoplasmic cells |
|
|
what is a thyroglossal cyst
|
persistant thyroid tissue along embryonal migration path in midlne of neck, anterior to larynx and hoid bone
|
|
|
gross thryoid adenoma
|
nodule, well encapsulated, solid, deep tan
|
|
|
histology of thyroid adenoma
|
cannot tell if invasive or non infasive
|
|
|
how do you tell if a follicular neoplasm is an adenoma or carcinoma?
|
-remove neoplasm to look for invasion of capsule or bld vessels
-examine the entire nodule, esp the capsule |
|
|
break down for types of thyroid carcinomas
|
papillary (70-80)
follicular (10-20) medullary (5) anaplastic (1-3) |
|
|
tx of papillary carcinoma
|
total thyroidectomy
|
|
|
gross papillary carcinoma
|
-granular or firm white lesion
-irregular borders |
|
|
histology of papillary carcinoma
|
papillary fronds (finger like progections) with fibrovascular cores, lined by cubodial cells
can have follicular appearing areas -nuclei with ground glass appearance or orphan annei eye -psammoma bodies -- concentrically calcifed structures w/in the papillae |
|
|
how do you dx papillary carcinoma?
|
fine needle aspiration
frozen section diagnosis |
|
|
how does papillary carcinoma spread?
|
via lymphatics to parathyrodial LN
|
|
|
prognosis of papillary carcinoma
|
spreads to lungs or brain
-rarely fatal -can invade jugular, carotid or airway -can undergo anaplastic differentiation |
|
|
gross follicular carcinoma
|
-solitarly
-may have capsule -may invade adj thyroid and is difficult to peal away from thyroid -invasion may be microscopic |
|
|
how does follicular carcinoma spread?
|
metastasis via veins to lungs and bones
|
|
|
how do follicular carcinomas usually present
|
solitary cold thyroid nodules
|
|
|
origin of medullary carcinoma?
|
arise from parafollicular cells (C cells) which are neural crest
|
|
|
how do you tx medullary ca
|
total thyroidectomy
|
|
|
carcinoma assoc with MEN2
|
medullary carcinoma
|
|
|
histololgy of medullary carcinoma
|
solid nests
-spindly shaped cells -amyloid deposits |
|
|
how is calcitonin used in medullary carcinoma tx
|
assess levels before and after thyroid removal
|
|
|
how does medullary carcinoma spread?
|
lymphatics and veins to bone, lungs, and liver
|
|
|
characteristics of MEN2
|
medullary thyroid carcinoma (usually and possibly only presentation)
pheochromocytoma hyperparathyroidism |
|
|
anaplastic thyroid carcinoma px?
|
very poor
|
|
|
histology of anaplastic thyroid carcinoma
|
undifferentiated
must do immunostains to determine origin |
|
|
lymphoma of thyroid gland
|
-usually arises in hashimoto's thyroiditis
-rarely primary in thryoid |
|
|
struma ovarii
|
thryoid tissue in ovary
|
|
|
what is scintigraphy
|
radioactive iodine scan
|
|
|
what information does scintigraphy scan give
|
-radioactive iodine is trapped by thyroid cells so you can see the thyroid anatomy; areas that are darker (less uptake) suggest are cold nodules
|
|
|
cold nodules
|
suggest malignicy
|
|
|
what are characteristics of a malignant thyroid nodule by ultrasound
|
hypoechogenicity
microcalcifications thick, irregular or abscent halo irregular margin invasive growth regional lymphadenopathy incr vascularity |
|
|
what are characteristics of a benign thyroid nodule
|
iso or hyperechoic
coarse calcifications thin, well defined halo regular margins lack of invasive growth no abnormal lymphadenopahty normal vascularity |
|
|
microcalcifications on US suggest
|
papillary thyroid carcinoma
|
|
|
when is CT scan useful to evaulate goiter
|
to see if there is tracheal compression
to evaluate substernal thyroid |
|
|
when are PET scans used for thyroid nodules
|
if pt has metastsis
|
