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Questions and Answers
Which type of thyroid malignancy originates from parafollicular cells?
Which type of thyroid malignancy originates from parafollicular cells?
What is the most common thyroid malignancy?
What is the most common thyroid malignancy?
Which feature is characteristic of papillary carcinoma of the thyroid?
Which feature is characteristic of papillary carcinoma of the thyroid?
In which age group is the incidence of papillary carcinoma most commonly found?
In which age group is the incidence of papillary carcinoma most commonly found?
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Which statement about the metastasis of papillary carcinoma is true?
Which statement about the metastasis of papillary carcinoma is true?
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What should be specifically asked during the assessment of a thyroid mass?
What should be specifically asked during the assessment of a thyroid mass?
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Which tests are necessary to confirm the thyroid status during the first assessment?
Which tests are necessary to confirm the thyroid status during the first assessment?
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What indicates the presence of T3 thyrotoxicosis in a patient?
What indicates the presence of T3 thyrotoxicosis in a patient?
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Which of the following is used to assess the morphology of the thyroid gland?
Which of the following is used to assess the morphology of the thyroid gland?
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What is the primary use of a needle core biopsy in thyroid diagnosis?
What is the primary use of a needle core biopsy in thyroid diagnosis?
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Which pattern is associated with functioning thyroid tissue after radioiodine administration?
Which pattern is associated with functioning thyroid tissue after radioiodine administration?
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In which scenario would a cold nodule typically be found?
In which scenario would a cold nodule typically be found?
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Which thyroid condition cannot be adequately sampled by fine-needle aspiration cytology (FNAc)?
Which thyroid condition cannot be adequately sampled by fine-needle aspiration cytology (FNAc)?
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What is the most common type of goitre in developed countries?
What is the most common type of goitre in developed countries?
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What condition typically presents with smooth thyroid enlargement?
What condition typically presents with smooth thyroid enlargement?
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In what type of patient does a solitary thyroid nodule most often indicate malignancy?
In what type of patient does a solitary thyroid nodule most often indicate malignancy?
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Which condition is commonly associated with painful and tender goitres?
Which condition is commonly associated with painful and tender goitres?
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What is a toxic or hot adenoma characterized by?
What is a toxic or hot adenoma characterized by?
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What is a potential consequence of late primary thyroid atrophy?
What is a potential consequence of late primary thyroid atrophy?
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What can cause a new enlargement of an existing goitre?
What can cause a new enlargement of an existing goitre?
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Lymphomas of the thyroid typically present with what kind of enlargement?
Lymphomas of the thyroid typically present with what kind of enlargement?
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What does the presence of hot nodules indicate?
What does the presence of hot nodules indicate?
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Which group of patients is most commonly treated with oral radioiodine?
Which group of patients is most commonly treated with oral radioiodine?
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Why is radioiodine therapy contraindicated in pregnancy?
Why is radioiodine therapy contraindicated in pregnancy?
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What is a potential consequence of using higher doses of radioiodine?
What is a potential consequence of using higher doses of radioiodine?
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What is the purpose of administering anti-thyroid drugs prior to surgery?
What is the purpose of administering anti-thyroid drugs prior to surgery?
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What is one of the reasons for performing a pre-operative laryngoscopy?
What is one of the reasons for performing a pre-operative laryngoscopy?
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What is the goal of surgical management in thyroid conditions?
What is the goal of surgical management in thyroid conditions?
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What effect does radioiodine therapy have on thyroid ophthalmopathy?
What effect does radioiodine therapy have on thyroid ophthalmopathy?
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Study Notes
Thyroid and Parathyroid Glands
- Goiter refers to any thyroid enlargement
- Colloid goiters are common in developed countries, caused by colloid distension
- Idiopathic diffuse or multinodular hyperplasia are other causes of goiter
- Endemic goiters are often linked to iodine deficiency, and are usually asymmetrical and soft
- Anaplastic carcinomas cause hard and firm thyroid swelling, often in the elderly, due to aggressive nature
- Lymphomas of the thyroid can also result in noticeable diffuse enlargement
- Graves' disease presents as a smooth thyroid enlargement
- Hashimoto's thyroiditis results in moderate, firm, and finely nodular enlargement
Solitary Thyroid Nodules
- These can be multinodular on imaging
- Small nodules may be incidental findings, observed during swallowing, as the thyroid moves up and down
- Idiopathic hyperplasia (thyroid adenoma) or thyroid cysts are possible explanations for solitary thyroid nodules
- Simple colloid goiters fall under the category of such nodules
- If a nodule appears during childhood, it most often indicates malignancy and requires exclusion via biopsy (FNA or needle core biopsy)
Hyperthyroidism
- A solitary adenomatous nodule sometimes produces excessive T4 independently of TSH levels
- This is known as a toxic/hot adenoma
Hypothyroidism
- Late result of primary thyroid atrophy (such as in Hashimoto's thyroiditis)
- Inflammation leading to fibrosis and atrophy
- Post-hyperthyroidism treatment with anti-thyroid drugs, radioiodine, or total thyroidectomy can also cause hypothyroidism
Investigating Thyroid Masses
- General thyroid status (euthyroid, hyperthyroid, or hypothyroid) is assessed initially
- Thyroid function tests and thyroid autoantibodies are measured
- Morphology of the gland is investigated (size, shape, consistency, effects on surrounding structures) using ultrasound, plain X-rays, CT scans
- Tissue diagnosis is obtained through FNAc or needle biopsy, incisional/excisional biopsy
Functional Activity of Glandular Tissue
- Radioiodine uptake assessment is used to evaluate thyroid function
- Four patterns can be observed: diffuse homogenous uptake (normal or hyperactive thyroid), generalized patchy uptake (multinodular goiters), cold nodules (likely tumors as they usually don't take up iodine), and hot nodules (toxic adenomas with excessive T4 secretion)
- Radioiodine scanning can help identify ectopic thyroid tissue (in the tongue or along the thyroglossal duct), retrosternal goiters, and metastatic thyroid carcinoma
Surgical Management
- Indicated when a quick and effective cure is needed (e.g., Graves' disease), patient is unresponsive to antithyroid drugs, or if a toxic multinodular goiter is present, preventing suppression of normal thyroid tissue
- Pre-operative assessment includes laryngoscopy to evaluate vocal cord function
- Thyroid function should be normalized before surgery; thyrotoxicosis can trigger cardiac arrhythmias
- Antithyroid medications and Lugol's iodine are given pre-surgery to reduce vascularity and ease excision.
Thyroid Malignancies
- Nearly all originate from follicular cells except for medullary carcinomas
- Papillary and follicular carcinoma are well differentiated, while anaplastic carcinomas are poorly differentiated and more aggressive
- Medullary carcinomas come from parafollicular cells secreting calcitonin
- Lymphomas typically arise from preexisting Hashimoto's thyroiditis
Papillary Carcinoma
- Most common thyroid cancer, affecting women more
- Develops between ages 30-45
- Fibrovascular stroma and psammoma bodies are often present
- Slow-growing and often multicentric
Follicular Carcinoma
- Similar presentation to benign adenomas, so distinction needs histology to confirm capsular or vascular invasion
- More common in women
- Prognosis depends on local invasion extent
Anaplastic Carcinoma
- Extremely aggressive and poor prognosis
- Often found in elderly patients
- Rapidly forms a hard and firm thyroid
- Spreads to trachea, esophagus, regions lymph nodes, and distant sites
Medullary Carcinoma
- Originates from parafollicular C cells, secreting calcitonin
- Presents with hypocalcemia and hypophosphoatamia and potentially other hormones like serotonin and ACTH-like peptides, and can be part of MENII
- Commonly spreads to lymph tissues and organs like lungs, bones, livers
- Resistant to radioiodine therapy and radiotherapy
- Surgically treated with total thyroidectomy and regional lymph nodes removed
Thyroid Lymphomas
- Develops in pre-existing Hashimoto's thyroiditis.
- Diagnosed via needle core biopsy
- Treated with radiotherapy
Goiters (Idiopathic, Non-toxic Hyperplasia)
- Begin as diffuse, micronodular enlargement, later becoming multinodular colloid goiters
- Thyroid cysts and solitary hyperplastic nodules are included in this category
- Usually euthyroid, but can become hyperthyroid if nodules become autonomously active
- Radioiodine scan shows heterogeneous, patchy uptake, due to varying activity of the enlarged nodules
- Surgery may be needed for cosmetic reasons, hyperthyroidism, sudden asymmetric change, compressive symptoms (like stridor or dyspnea), or possible malignancy suspected
Congenital Thyroid Disorders
- Thyroid originates from a midline diverticulum between the first two branchial pouches
- Forms the thyroglossal duct which eventually disappears
- Thyroglossal cysts are midline neck masses, often inferior to hyoid but sometimes submental, that can be diagnosed by asking patient to protrude tongue (cyst moves)
- Ectopic thyroid tissue may be rare, but can be the only thyroid tissue present in a patient, detected by radioiodine scans
Parathyroid
- Lumps from parathyroid glands usually due to hyperparathyroidism
- Common cause is single parathyroid adenoma (benign tumor)
- Diffuse parathyroid hyperplasia involves more than one gland, causing excessive PTH
- Parathyroid carcinoma is rare, leading to hypercalcemia and hypophosphatemia
- Diffuse hyperplasia is a secondary condition, linked to renal failure or vitamin D deficiency
- Surgical management (e.g., removal of affected gland) is the primary treatment for most cases
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Description
This quiz covers the essential aspects of the thyroid and parathyroid glands, including conditions such as goiter and hormonal disorders. It examines various types of thyroid enlargement and nodules, their causes, and related diseases like Graves' and Hashimoto's. Test your knowledge on these critical components of the endocrine system.
