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187 Cards in this Set
- Front
- Back
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The condition in which the body lacks sufficient thyroid hormones is _____.
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hypothyroidism
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What are some clinical signs of hypothyroidism?
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myxedema, weight gain, hair loss, lethargy
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Sever hypothyroidism characterized by dry skin & swellings is ____.
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myxedema
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Myxedema is more common in ____.
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women
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With both hypo & hyper thyroidism the thyroid is ____.
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enlarged
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What can untreated hypothyroidism result in?
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retarded growth, decreased mental activity & decreased body temp.
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Primary hypofunction of the thyroid is known as ____ ____ disease.
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intrinsic thyroid
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What are 3 causes of hypothyroidism?
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low intake of iodine, thyroid hormone failure, and disease of the hypothalamus/pituitary
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Oversecretion of thyroid hormones is called _____.
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hyperthyroidism
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What are 3 causes of hyperthyroidism?
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abnormal hormone secretion, neoplasms causing oversecretion, & grave's disease
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In areas not deficient in iodine, ____ ____ are believed to cause most thyroid disease.
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autoimmune processes
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A ____ is enlargement of the thyroid gland that is nodular & sometimes hetero.
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goiter
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What is the most common thyroid abnormality?
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goiter
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Goiters are due to ____/____ of the follicular epithelium.
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hypertrophy/hyperplasia
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What causes hyperplasia?
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TSH
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What are 4 other causes of a goiter?
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thyroiditis, inflammation, neoplasm, cysts
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Goiters may be ____ & ____ or they can be ____ & ____.
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diffuse & symmetric or
irregular & nodular |
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T or F. Normal thyroid function an cause enlargement of the gland.
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TRUE
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What are the 2 types of goiters?
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1. simple (non-toxic)
2. multinodular (toxic) |
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The term nontoxic goiter refers to ____ ____ of the thyroid.
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diffuse enlargement
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What are nontoxic goiters NOT associated with?
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They are NOT associated with overprodiction of TSH or malignancy
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A nontoxic goiter is AKA an ____ goiter.
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endemic
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What is a nontoxic goiter caused by?
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dietary insufficiency of iodine
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Nontoxic goiters are uncommon in the US & more frequent in ____ during ____.
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females, puberty
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A nontoxic goiter is not associated w/ hyper or hypothyroidism but can lead to ____.
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hypothyroidism
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In the 1st stage of a nontoxic goiter ____ occurs.
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hyperplasia
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What happens in the 2nd stage of a nontoxic goiter?
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colloid involution occurs
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What are the US findings of a nontoxic (simple) goiter?
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enlarged thyroid (smooth or nodular) w/ 1 side larger & with possible compression of other structures
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What are the different names for a toxic goiter?
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adenomatous hyperplasia, nodular hyperplasia, or multinodular goiter
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One of the most common forms of thyroid disease is ____ ____.
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toxic goiter (5% of pop.)
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About ____% of nodular thyroid disease is caused by hyperplasia of the gland.
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80%
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A toxic goiter is ____ times more common in females than males.
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10 - 20 times
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When does a toxic goiter occur most frequently?
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Between ages 50-70
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A toxic goiter is a ____ condition & results from ____ of the gland.
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hyperthyroid, hyperactivity
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T or F. The etiology of a toxic goiter is unknown.
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TRUE
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What are some theories on toxic goiters?
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can be the end stage of a nontoxic goiter
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What is the sonographic appearance of a toxic goiter?
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diffusely inhomogeneous, enlarged / no normal tissue & multiple discrete nodules or calcifications may be present
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The differential diagnosis of a toxic goiter is a ____ or ____.
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neoplasm or cyst
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Hyperthyroidism is most often associated w/ ____ ____.
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grave's disease
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What is the most common cause of hyperthyroidism?
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grave's disease
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The thyroid gland releases the hormones ____ & ____ which control metabolism.
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thyroxine (T4) & triiothroynine (T3)
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What is grave's disease caused by?
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abnormal immune system response that causes too much thyroid hormone
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An autoimmune condition that occurs when the body attacks & destroys healthy tissue is ____ _____.
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grave's disease
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Grave's disease is more common in ____ over the age ____.
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women, 30
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Grave's disease is characterized by a triad of findings. What are they?
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hypermetabolism, diffuse toxic goiter, exopthalamos, and cutaneous manifestations
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What is the sonographic appearance of the thyroid in someone w/ grave's?
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enlarged w/ hypoechoic texture w/o palpable areas but IS lobulated
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What is the characteristic US finding of Grave's disease?
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increased vascularity thru the cardiac cycle (AV shunt)
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The term ____ ____ refers to the increased vascularity associated w/ graves.
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thyroid inferno
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A thyrotoxic crisis is AKA a ____ ____.
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thyroid storm
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What is a thyrotoxic crisis?
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an acute situation in a patient w/ uncontrolled hyperthyroidism
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What are the symptoms of a thyrotoxic crisis?
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fever, sweating, tachycardia, pulmonary edema, & nervous excitability
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A thyrotoxic crisis is precipitated by ____ or ____.
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infection or stress
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Inflammation of the thyroid causing swelling & tenderness is ____.
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thyroiditis
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What is thyroiditis caused by?
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infection or autoimmune abnormalities
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What are the 2 types of thyroiditis?
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Hashimoto's and deQuervains
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What is the most common form of thyroiditis?
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Hashimoto's
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What is hashimoto's?
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a distinctive autoimmune disorder which leads to chronic inflammation of the thyroid
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The most common cause of hypothyroidism in adults is ____ ____.
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hashimoto's thyroiditis
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Hashimoto's is often ____ w/ diffuse ____ which may be asymmetric.
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painless, enlargement
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Hashimoto's is more common in ____ & is associated w/ an increased risk of ____.
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women, malignancy
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Initially hashimoto's appears ____ & ____ but as the disease progressed it results in ____ ____.
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homogeneous & nodular, inhomogeneous enlargement
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Hashimoto's may be difficult to distinguish from a ____ ____ on US.
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multinodular goiter
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What is the sonographic appearance hashimoto's thyroiditis?
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diffusely abnormal w/ coarse hypoehcoic appearance, thick fibrous strands, increased vascularity & LN enlargement
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With hashimoto's the gland becomes ____, ____ & ____ over times.
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fibrotic, ill-defined, and heterogeneous
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What is deQuervain's thyroiditis?
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diffuse inflammation w/ enlargement & tenderness
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What is deQuervain's usually caused by?
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viral infection
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With deQuervain's there is ____ to ____ pain.
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mild to severe
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DeQuervain's may cause ____ ____.
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transient hyperthyroidism
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Within weeks or months, the symptoms of deQuervain's ____.
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subside
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An uncommon inflammatory condition secondary to a bacterial infection is ____ ____ ____.
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acute suppurative thyroiditis
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With acute suppurative thyroiditis sonographically the thyroid is ____ & ____.
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enlarged & painful
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An ____ ____ may be seen w/ acute suppurative thyroiditis.
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intrathyroidal abscess
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To produce or discharge pus as a result of injury/infection is called ____.
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suppurate
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Relating to, or consisting of pus is ____.
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purulent
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Simple cysts of the thyroid are ____.
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rare
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Most cysts are thought to be cystic degeneration of a ____ ____.
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follicular adenoma
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Most cystic areas of the thyroid contain some ____ ____ or ____.
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solid tissue or blood
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What are hemorrhagic cysts a result of?
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blunt trauma or acute hemorrhage into a follicular adenoma
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Pathologically most cysts are found to be ____ or ____ ____ that have undergone degeneration/necrosis.
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colloid or adenomatous nodules
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A thick gelatinous substance that is produced & stored in the thyroid is a ____.
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colloid
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A benign tumor w/ cells arranged in patterns similar to those of a gland is called an ____.
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adenoma
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A ____ ____ is a true benign neoplasm encapsulated by fibrous tissue.
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follicular adenoma
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Follicular adenoma's generally appear as ____, ____, ____ masses.
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solitary, well-defined, round
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Approx. ____% of seemingly solitary masses prove to be adenomas.
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30 - 50%
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Follicular adenomas are usually ____ echogenic than normal thyroid glands.
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less
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A ____ ____ is present around the adenoma in about ____% of cases.
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peripheral halo, 50%
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On nuclear med tests, most follicular adenomas are ____.
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cold
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Follicular adenomas frequently contain variable amounts of ____ ____ ____ & ____.
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internal cystic degeneration & calcifications
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An area of decreased radionuclide may be called a ____ nodule.
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cold (underactive)
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What can produce a cold spot?
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cysts, hypothyroidism, benign growths, inflammation or cancer
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Single nodules that are not functioning are malignant in about ____% of cases.
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10 - 20%
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Presence of non-functioning nodules increases the probability of ____.
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malignancy
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Nodules that are "____" are rarely malignant.
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hot
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Multiplicity of nodules in the thyroid is more suggestive of ____ disease & is seen in pts w/ a ____ ____.
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benign, multinodular goiter
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Thyroid cancer is ____ & approx ____% of solitary thyroid nodules are malignant.
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rare, 5%
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Thyroid cancer accounts for ____% of cancer deaths in the US.
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0.4%
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When is thyroid cancer most common?
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B/t ages 40-60 (twice as common in women)
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T or F. Most thyroid cancer is associated w/ previous exposure to low-dose ionizing radiation.
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TRUE
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Thyroid cancer on US is highly ____.
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variable
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Thyroid cancer on US has ____ borders and is usually _____.
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poorly-defined, homogeneous
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Calcifications are present in ____% of thyroid cancer.
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50 - 80%
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A solitary thyroid nodule in the presence of cervical adenopathy on the same side suggests ______.
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malignancy
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What is the most common type of thyroid cancer?
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papillary cancer
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Papillary cancer accounts for ____% of all thyroid cancer.
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60 - 70%
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Usually papillary cancer is ____ & ____.
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asymptomatic & slow-growing
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What does metastisizes with papillary cancer?
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lymph nodes, cervical musculature, larynx, and lungs
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Papillary cancer may be ____ or almost completely ____.
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solid, cystic
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In 90% of cases, papillary cancer is ____ & ____.
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hypoechoic & hypervascular
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The sonographic appearance of papillary cancer is characterized by microcalcifications called ____ ____.
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psammoma bodies
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What are psammoma bodies?
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round collections of calcium
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There is possible cervical lymph node mets in approx. ____% of papillary cancer cases.
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20%
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Follicular adenocarcinoma comprises approx ____% of thyroid cancer.
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20 - 25%
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Follicular adenocarcinomas are usually a ____ ____ & are ____ ____.
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solitary mass, slow growing
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T or F. Follicular adenocarcinoma is more aggressive than papillary cancer.
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TRUE
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What is the sonographic appearance of a follicular adenocarcinoma?
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irregular, firm with nodular enlargement
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Follicular carcinoma tends to metastisize to ____ & ____ via the bloodstream.
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lung & bone
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Medullary cancer is less common & accounts for ____% of thyroid cancer.
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5 - 10%
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With medullary cancer there are increased ____ levels.
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calcitonin
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About ____% of the time, medullary cancer forms sporadically.
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80 - 90%
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What is sipple syndrome?
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associates tumors of the adrenal system w/ medullary cancer
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Medullary cancer presents as a ____, ____ mass.
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hard, bulky
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Medullary cancer causes abnormal ____ ____ levels.
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serum calcitonin
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When occurence of medullary cancer is sporadic, it is most frequently seen b/t ages ____.
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50 - 60
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When meduallary cancer is in association w/ sipple syndrome it is most frequently seen in ____ & ____.
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children & teens
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What is the appearance of medullary cancer on US?
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hypoechoic w/ focal hemorrhage or necrosis
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There are ____ w/in a medullary cancer mass.
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calcifications
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US is highly sensitive in detecting metastic _____ in meduallary cancer patients.
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lymphadenopathy
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What does the term anaplastic mean?
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undifferentiated, and characterized by the loss of distinctive cell features
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Anaplastic cancer is ____ & accounts for less than ____% of thyroid cancers.
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rare, 10%
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What are the characteristics of anaplastic cancer?
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hard, fixed mass w/ rapid growth
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Anaplastic cancer usually occurs after ____ years of age & is nearly impossible to remove.
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50
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Death from anaplastic cancer is usually caused by ____ & ____.
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compression & asphyxiation
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What is the sonographic appearance of anaplastic cancer?
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hypoechoic mass w/ diffuse glandular involvement that invades surrounding structures
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What are 2 clinical signs of lymphoma?
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rapidly growing mass in the neck & can be associated w/ hashimoto's
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What are the sonographic findings of lymphoma?
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non-vascular, hypoechoic, lobulated mass w/ possible necrosis
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Lymphomas cause a ____ thyroid.
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heterogeneous
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Hot spot=
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overactive
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Cold spot=
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underactive
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Hot spots absorb ____ amounts of radionuclide & cold spots absorb ____.
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large, little/none
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A solitary "cold" nodular has ____% chance of being malignant.
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15 - 20%
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What is the most common cause of primary hyperparathyroidism?
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parathyroid adenomas
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Benign tumors which are extremely small & difficult to locate are called ____ ____.
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parathyroid adenomas
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When someone has a parathyroid adenoma they may have a history of ____ ____ exposure.
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ionizing radiation
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Parathyroid adenomas are usually ____.
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singular
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What are the 4 lab values associated with parathyroid adenomas?
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elevated serum PTH, hypercalcemia, hypophosphatemia, and excessive excretion of calcium
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What are some clinical findings associated w/ parathyroid adenomas?
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hypercalciuria, hypertension, pancreatitis, peptic ulcers, cholelithiasis, osseous changes
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Parathyroid adenomas on US generally appear as ____, ____, ____ masses.
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small, round, retrothyroid
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The echogenecity of a parathyroid adenoma is usually ____ than the normal thyroid.
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less
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What are the characteristics of a parathyroid adenoma?
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solid, with cystic changes & calcifications
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What are 2 scanning pitfalls when imaging parathyroid adenomas?
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confusing other structures, and trying to image near or below clavicle bones
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Parathyroid carcinoma is ____.
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rare
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What does parathyroid carcinoma cause?
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hyperparathyroidism & very high calcium levels
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What are characteristics of cancer within the parathyroid glands?
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small, irregular, and firm
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What must be present for parathyroid carcinoma to be diagnosed?
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mets to regional nodes or distant organs, capsular invasion or local recurrence
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Parathyroid carcinoma is ____ & more ____ & ____ than most benign adenomas.
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larger, lobulated & inhomogeneous
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Asymmetric enlargement of the ____ ____ artery on the side of the lesion may be seen in the region of the ____ ____.
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inferior thyroid, neurovascular bundle
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What does the neurovadcular bundle consist of?
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inferior thyroid artery & laryngeal nerve
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A congenital abnormality that may be found in the midline of the neck anterior to the trachea is a _____ ____ ____.
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thyroglossal duct cyst
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Thyroglossal duct cysts usually form ____ ____ that does not exceed ____ cm in size.
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fusiform swelling, 2-3 cm
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Thyroglossal duct cysts are rarely a source for ____ but may produce ____ ____.
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malignancy, draining sinuses (drain into base of tongue)
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What are the clinical signs for a thyroglossal duct cyst?
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palpable midline mass & pain associated w/ hemorrhage or infection
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What does a thyroglossal duct cyst look like on US?
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cystic mass in midline anterior to the trachea w/ internal echoes from hemorrhage or infection
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A primarily cystic mass seen lateral in the neck near the carotid vessels is a ____ ____ ____.
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brachial cleft cyst
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Brachial cleft cysts are remnants of ____ ____ that are ____ to the thyroid.
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embryonic development, lateral
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Brachial cleft cysts may contain ____ ____ echoes or ____ ____.
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low level, solid components (from infection/hemorrhage)
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Brachial cleft cysts represent a ____ of the brachial cleft.
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diverticulum
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A congenital lymphatic malformation found posteriolateral on the neck is a ____ ____.
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cystic hygroma
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What is the sonographic appearance of a cystic hygroma?
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thin walled, cystic multiloculated mass
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A benign tumor made up of blood or lymph vessels is a ____.
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angioma
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A benign lesion of the sternocleidomastoid muscle is called a ____ ____.
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fibromatosis colli (FC)
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What is another term for fibromatosis colli?
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sternocleidomastoid tumor or infancy
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Fibromatosis colli pathogenesis is unclear but probably related to ____ ____.
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birth trauma
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A fibromatosis colli lesion is within the lower ____ of the sternocleidomastoid muscle.
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1/3
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Fibromatosis colli lesions are usually ____ & slightly more common on the ____ side.
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unliateral, right
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Approx ____ of fibromatosis colli cases resolve spontaneously.
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2/3
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What is a fibromatosis colli lesion associated with?
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torticolli due to contraction of the sterno muscle
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What does torticolli mean?
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torti=twisted
colli=neck |
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Involuntary contractions of the neck muscles that could be a sign for an underlying disease is called ____.
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torticollis
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Within the neck, the ____ of the node is important.
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shape
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Normal nodes are ____ w/ a central ____ ____ complex.
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oval, core echo
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The more round the node, the more likely it is to be ____.
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malignant
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What are the treatments for hyperthyroidism?
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antithyroid meds, radioactive iodine, and surgery
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What are the 2 antithyroid meds used?
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propylthiouracil (PTU) & methimazole (tapazole)
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A variety of factors affect the decision of whether to treat a patient for _____.
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hypothyroidism
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What 3 things do doctors consider before hypothyroidism treatment?
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age of pt & presence of other medical problems that would benefit/worsen
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A synthetic thyroid hormone called _____ is the treatment of choice for hypothyroidism.
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levothyroxine
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It usually takes up to ____ weeks before symptoms of hypothyroidism resolve w/ meds.
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6 weeks (many are better by 2-3)
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