surgery: thyroid
Terms
undefined, object
copy deck
- arterial supply to thyroid
-
external carotid --> superior thyroid artery
subclavian --> thyrocervical trunk --> inferior thyroid
aortic arch --> thyroid ima - venous drainage of thyroid
- superior, middle and inferior veins --> internal jugular
- thyroid malignancy spreads to which nodes
-
cervical nodes,
paratracheal nodes, or
tracheoesophageal groove nodes (worst! may go into recurrent nerve, trachea or esophagus) - innervation of thyroid
-
recurrent laryngeal (crosses over inferior thyroid artery on right) --> external (larynx sensory) and internal (larynx mm)
superor laryngeal nerve --> external (cricothyroid mm) and internal (larynx sensory) - thyroid originates from and migrates down from the...
- foramen cecum at the base of the tongue
- substernal goiters usually are from .... do/don't take up radioiodine...and result in ...
-
adenomatous hyperplasia
don't take up radioiodine
tracheoesophageal compression - __ and __ join to form T3 and T4
- iodine and tyrosine
- Parafollicular cells (C cells) make ___ and are part of which cell system?
-
calcitonin
APUD - is the preferred tx of Grave's disease medical or surgical?
-
medical by
1. PO radioiodine (they tend to remit spontaneously)
2. propylthiouracil and methimazole (inhibit peroxidase so iodide -x> iodine and inhibits T3 -> T4)
BEWARE drug induced SLE, agranulocytosis - name four complications of thyroidectomy
-
thyroid storm (prevent by first making patient euthyroid)
hemorrhage
hypoparathyroidism (Chovstek's and Trousseau's; tx with IV ca gluconate)
recurrent laryngeal n. injury - what are the eponyms for 1. diffuse toxic non-nodular goiter and 2. toxic multinodular goiter
-
1. Grave's disease
2. Plummer's disease - do the nodules in plummer's disease uptake radioiodine? are they suppressed by thyroxine?
-
yes
no - toxic adenoma of thyroid is caused from?
- autonomous hyperfunctioning solitary nodule
- tx of toxic adenoma/
- surgical excision (lobectomy)
- tx of plummer's disease?
- same as for Grave's (medical first, then surgical)
- how do you distinguish de Quervains thyroiditis (giant cell/granulomatous) from Grave's?
- de Quervains does not take up radioiodine (and therefore antithyroid drugs are ineffective)
- two forms of chronic thyroiditis
-
hashimoto's (struma lyphomatosa; eu- or hypothyroid, has anti-thyroid antibodies, tx with thyroxine)
Riedels (fibrous)thyroiditis- gland is replaced with fibrous tissue --> rock hard --> may cause pressure sx like cough) - MCC thyroid surgery
- neoplasm
- risks factors for thyroid malignancy vs. benign neoplasm
-
men
>age 40
family hx of MEDULLARY thyroid CA
radiation exposure hx
firm nodulesinfiltration
multiple nodules
lymph nodes (ipsilateral)
immobility of vocal cord - MC thyroid malignancy
- papillary carcinoma (esp women with radiation hx)
-
thyroid malignancy associated with ...
radiation exposure?
iodine deficiency?genetically?
from other thyroid neoplasms? -
papillary
follicular
medullary (make calcitonin)
anaplastic