Osler Thyroid

Front 1

What artery supplies the superior thyroid artery?

Back 1

External Carotid Artery

Front 2

What artery supplies the inferior thyroid artery?

Back 2

Thyrocervical trunk

Front 3

T/F: there is a middle thyroid artery

Back 3

FALSE. Just a superior and inferior.

Front 4

Where do the thyroidal veins drain?

Back 4

internal jugular

Front 5

The recurrent laryngeal nv is a brach of?

Back 5

the vagus nerve

Front 6

Where is the left recurrent laryngeal nv is found?

Back 6

tracheo-esophageal groove (predictable)

Front 7

where is the right recurrent laryngeal nv is found?

Back 7

may be anomolous. (less likely to be recurrent traveling around the arch of the aorta). can come off anywhere along the vagal trunk.

Front 8

What does the Superior Laryngeal Nerve innervate?

Back 8

innervates cricothyroid

Front 9

Injury to the superior laryngeal nerve results in?

Back 9

loss of projection and easy voice fatigability (opera singers)

Front 10

injury to the recurrent laryngeal nerve results in?

Back 10

hoarseness

Front 11

Why is bilateral injury to the recurrent laryngeal nerve dangerous?

Back 11

can obstruct the airway. may need an emergent tracheostomy.

Front 12

What is the most common cause of hyperthyroidism in the US?

Back 12

Graves disease
(autoimmune)

Front 13

Which sex is Graves most common in?

Back 13

women

Front 14

Treatment of Graves, in order of preference?

Back 14

1) Thioamides (70% recurrence)
2) I 131 (10% recurrence)
3) Surgery, near total thyroidectomy (10% recurrence)

Front 15

Treatment of choice for immediate control of thyrotoxicosis? (say you need to operate urgently).

Back 15

beta blockade (usually inderal 1mg q15min)

Front 16

Most common cause of hyperthyroidism outside the US?

Back 16

Toxic multinodular goiter

Front 17

MC age group for multinodular goiter?

Back 17

women >50

Front 18

Physiology behind toxic multinodular goiter?

Back 18

Hyperplasia secondary to chronic low grade TSH stimulation. thyroid function tests are normal.

Front 19

Treatment for multinodular goiter?

Back 19

1) medical treatment (thioamides, I131)
2) surgery (subtotal thyroidectomy)

Front 20

Physiology behind Graves disease?

Back 20

IgG antibodies to TSH receptor cause hyperthyroidism

Front 21

Treatment for solitary toxic nodule in order of preference?

Back 21

1) I131 and thioamides
2) lobectomy if medical treatment ineffective

Front 22

What is the MCC of hypothyroidism in adults?

Back 22

Hashimotos thyroiditis

Front 23

How is Hashimotos thyroiditis diagnosed?

Back 23

antimicrosomal and antithyroglobulin antibodies seen on titers

Front 24

Treatment for Hashimotos thyrioditis?

Back 24

NONSURGICAL.
thyroxine should cause regression of goiter.

Front 25

Treatment for subacute thyroiditis?

Back 25

NSAIDs, steroids

*only surgical in recalcitrant cases*

Front 26

A young female with an antecedent viral URI then develops dysphagia and tenderness in the thyroid area with normal thyroid function tests. What has she most likely developed?

Back 26

subacute (bacterial) thyroiditis

*nonsurgical. treat with NSAIDS and sometimes steroids*

Front 27

A goiter with woody or fibrous components involving adjacent strap muscles and carotid sheaths is most likely?

Back 27

Riedel's fibrous stroma

*treated wtih steroids and thyroxine*
*if airway compressioin may need surgery*

Front 28

In a thyroid nodule that is likely malignant, will the nodule return as cold or hot on scintigraphy?

Back 28

cold nodule

Front 29

MC thyroid cancer?

Back 29

Papillary carcinoma (80-90%)

Front 30

How does papillary thyroid cancer spread?

Back 30

lymphatogenous

Front 31

What is the most common route of spread for follicular thyroid cancer?

Back 31

hematogenous

(look for mets via CXR)

Front 32

of all medullary thyroid cancers, what % have a familial association?

Back 32

10%

(associated with MEN IIA or IIb)

Front 33

How is minimal/incidental papillary thyroid cancer <1cm in size treated?

Back 33

treated by total lobectomy with isthmusectomy

Front 34

How is papillary thyroid cancer >1cm treated?

Back 34

thyroidectomy

Front 35

Which thyroid cancer type is associated with calcitonin?

Back 35

medullary

(tumor arises from parafollicular C cells which secrete calcitonin)

Front 36

Which thyroid cancer type is associated with amyloid deposition on pathology?

Back 36

medullary

(apple green birefringence)

Front 37

which type of extrathyroidal cancer has a propensity to metastasize to the thyroid?

Back 37

renal cell carcinoma

Front 38

How are metastases for papillary cancer treated?

Back 38

I 131

Front 39

How is a suboptimal surgical resection for papillary CA treated? (ie. dirty margins, LN mets)

Back 39

I 131

Front 40

Treatment for microinvasive follicular thyroid CA <1cm?

Back 40

thyroid lobectomy

Front 41

Where is follicular thyroid CA likely to metastasize?

Back 41

bone, lung, liver.

Treat with I 131

Front 42

Treatment of choice for medullary CA >1cm in size?

Back 42

total thyroidectomy, ipsilateral cervical lymphadenectomy

Front 43

If a patient with medullary thyroid cancer has clinically positive lymph nodes in the neck: what is the treatment?

Back 43

thyroidectomy with modified radical neck dissection

Front 44

What is the 5 year survival rate for medullary thyroid carcinoma?

Back 44

50% 5 year survival

Front 45

Hurthle cell carcinoma is a variant of what type of thyroid cancer?

Back 45

follicular

Front 46

Which type of thyroid cancer does not take up iodine or synthesize thyroid hormone?

Back 46

Hurthe cell CA

*No role for postop I 131*

Front 47

Treatment for Hurthle cell thyroid carcinoma?

Back 47

total thyroidectomy

Front 48

From what type of thyroid cancer is anaplastic thyroid cancer thought to develop from?

Back 48

follicular carcinomas

Front 49

Why can follicular thyroid carcinoma NOT be diagnosed by FNA?

Back 49

2 things required for diagnosis of Follicular carcinoma:
lymphovascular invasion
capsular invasion
*cannot be seen by FNA

Front 50

If an FNA of a thyroid nodule is biopsied via FNA and comes back as follicular cells, what should be done?

Back 50

an ipsilateral thyroid lobectomy.

(possible that it is follicular carcinoma)

Front 51

A history of radiation therapy to the neck causes increased risk of?

Back 51

papillary thyroid cancer

Front 52

T/F: areas with iodine deficiency result in increased incidence of multinodular goiter, thereby increased incidence of thyroid cancer.

Back 52

TRUE

Front 53

T/F: Gardner's and Cowden's syndromes both have an increased risk of thyroid carcinoma.

Back 53

TRUE

Front 54

Four indications for postoperative radiation with I 131 (papillary and follicular thyroid cancer).

Back 54

1. > 2cm
2. nodal metastases
3. transcapsular spread
4. distant metastases

Front 55

T/F: radioactive iodine is effective in Hurthle cell and medullary carcinomas.

Back 55

FALSE!

only effective in papillary and follicular carcinomas

Front 56

Risk of hemorrhage during thyroidectomy?

Back 56

~1%

Front 57

Risk of Nerve injury during thyroidectomy?

Back 57

1-3%

Front 58

Risk of permanent hypoparathyroidism following total thyroidectomy?

Back 58

1-2%

Front 59

Risk of temporary hypoparathyroidism following total thyroidectomy?

Back 59

20%

Front 60

Rocaltrol is...?

Back 60

the active form of vitamin D