Endocrine - Surgery - Thyroid

Front 1

What are some causes of non-endemic goiter?

Endemic goiter is due to lack of:

Most accepted theory of goiter is:

Back 1

excess iodine (amiodarone, kelp in health food, synthroid, antithyroid drugs, lithium)
ionizing radiation

iodine

TSH stimulation - follicular necrosis/hemorrhage , vascular supply can't keep up

Front 2

Three causes of toxic multinodular goiter:

How are most nodules discovered?

What sort of questions should you ask of the patient?

Some S/S of retrosternal/intrathoracic goiter:

Back 2

Grave's, single toxic adenoma, diffuse toxic thyroiditis

physician finds during routine exam

rate of growth, hoarseness, radiation exposure, pain

dysphagia, stridor, dyspnea, cough

Front 3

What % of patients are euthyroid at presentation?

Why should you palpate the neck?

hard, fixed nodular mass is probably:

most common benign nodule of thyroid:

Back 3

80%

mets from thyroid ca

malignant

either single, multiple nodular goiter

Front 4

First step in lab testing:

If abnormal, then what?

Helpful in dx'ing thyroiditis:

Imaging to check size and consistency of mass:

Scan for hot vs cold nodules:

Back 4

TSH level

free T4 - if normal, then T3

anti-microsome (anti-peroxisome)
anti-Tg

U/S

I-123

Front 5

Most useful test for evaluating thyroid nodules:

Use of CXR, CT:

Problems with levothyroxine therapy:

Efficacy of anti-thyroid drugs:

Back 5

fine needle aspiration

check tracheal deviation, narrowing, eval for substernal growth

rebound growth, frank/subclinical hyperthyroid possible

very low- 95% rebound after D/C meds

Front 6

Best tx for TMNG?

How effective is subtotal thyroidectomy?

When is yearly TSH levels/palpatory exam OK as tx?

Back 6

radioiodine therapy (RAIU)

more effective in achieving euthyroid state than RAIU(6 wks vs 16 wks)

small-moderate NTMNG, asymptomatic, euthyroid, benign nodules

Front 7

Tx for large NTMNG?

Best tx for TMNG?

Most common inflammatory thyroiditis, most common cause of goiter:

High circiulating Ab's to:

Back 7

surgery is preferred

surgery - euthyroid achieved quicker than RAI

Hashimoto's

TPO, Tg

Front 8

Typical clinical presentation for Hashimoto's:

Tx?

When is surgery indicated?

Back 8

middle-aged female, asymptomatic non-painful mass in neck, feeling of fullness

Synthroid if hypothyroid, supression may be helpful if TSH is normal to decrease goiter size

when mass is malignant

Front 9

Painless, silent thyroiditis, autoimmune, TPO Ab's:

Most common cause of painful thyroiditis, viral in origin, usually post-URI:

Lab values:

Tx for thyrotoxicosis?

Back 9

subacute lymphocytic thyroiditis

DeQuervain's - subacute granulomatous thyroiditis

thyrotoxicosis in 50%, low TSH, ESR elevated (normal excludes this disease)

BB's

Front 10

Other common causes of a painful thyroid:

Two fundamental questions for thyroid eval:

Most sensitive method of determining thyroid status:

Most sensitive marker for autoimmune dysfunction:

Back 10

acute hemorrhage, rapidly expanding carcinoma, radiation thyroiditis, globus hystericus

metabolic status, etiology?

TSH level

anti-TPO

Front 11

Most complete screening exam for thyroid:

What % of T4 is bound, inactive?

How is serum TSH a good gauge of free T4?

Back 11

serum TSH, AMA level

99% - 1% active

pituitary senses small changes in T4, alters TSH levels

Front 12

Most common cause of subclinical hyperthyroid:

Other causes:

What should you always check in these patients?

Physical findings:

Back 12

overzealous Synthroid therapy

toxic solitary adenoma
early Grave's

AMA titer

nervousness, palpitations, low/absent TSH

Front 13

Systemic effects of subclinical hyperthyroid:

Subclinical hypothyroid:

Back 13

4x risk of Afib; higher risk of osteoporosis

15% of general population, usually women >65
TSH mildly elevated, T4 normal
mild increase in diastolic BP
TSH elevation --: elevated LDL, decreased HDL

Front 14

T-99 characteristics:

I-131 characteristics:

Differences between I-123 and I-131:

Back 14

cheap, safe, helpful to determine size, shape, etc; recommended for children

better for lingual/retrosternal thyroid, can see "hot" and "cold" nodules;

I-123: image studies for RAI therapy
I-131: eval of thyroid ca mets afer surgery, ablation

Front 15

Role of U/S in thyroid eval:

Role of CT/MRI:

Principal way to eval a solitary nodule:

Back 15

best method to see size and consistency of mass - can detect nodules to 2 mm diameter, best suited for obese patients who are difficult to palpate

NONE

fine needle aspirate

Front 16

Malignancy easily detected by FNA:

Pitfalls of FNA:

Risk factors for malignancies:

Back 16

papillary carcinoma

indeterminate lesion may be benign/malignant;
false-negatives from large cystic lesions, clinical inexperience
nodules >3 cm need multiple FNA's

Family hx, hx of RT

Front 17

Most common thyroid carcinoma, seen in all ages, best prognosis:

2nd most common, usually elderly pts, can be stimulated by elevated TSH:

How to diagnose follicular carcinoma:

Back 17

papillary carcinoma

follicular carcinoma

hard by FNA, need biopsy

Front 18

Compare neck node mets risk between papillary/follicular:

Tumor of C cells, (parafollicular), increased serum calcitonin:

highly aggressive, highly lethal, life expectancy ~2 months:

Back 18

papillary - 75% risk
follicular - 10% risk, but higher risk for distant mets because of vascular invasion

medullary

anaplastic

Front 19

Chronic autoimmune thyroiditis is seen commonly with which lymphoma?

What is elevated in thyroid carcinomas?

Post-op eval:

Back 19

non-Hodgkins

serum Tg, except for medullary carcinomas

eval q 6-12 months, I-131 scans yearly until no activity, annual serum Tg