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Emryologic origin of thyroid
1st and 2nd pharyngeal pouch
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Factor from hypothalamus that causes TSH release from anterior pituitary
TRH
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Hormone released from anterior pituitary gland that acts on the thyroid
TSH
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1st branch off external carotid artery
Superior thyroid
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Branch of thyrocervical trunk; supplies inferior and superior parathyroids
Inferior thyroid
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Superior and middle thyroid veins drain into . . .
Internal jugular vein
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Inferior thyroid vein drains into . . .
Innominate vein
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Motor nerve to cricothyroid muscle
Superior laryngeal nerve
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Injury resulting in loss of voice projection and voice fatiguability
Superior laryngeal nerve
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Motor nerve to all larynx except cricothyroid
Recurrent laryngeal nerve
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Injury resulting in hoarseness and potential obstruction of airway
Recurrent laryngeal nerve
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Nerve that tracks close to superior thyroid artery
Superior laryngeal nerve
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Nerve that runs in tracheoesophageal groove
Recurrent laryngeal nerve
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Course of left RLN
Loops around aorta
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Course of right RLN
Loops around right subclavian/innominate
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Posterior medial suspensory ligament close to RLNs
Ligament of Berry
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Binder that stores T3 and T4 in colloid
Thyroglobulin
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Binder for thyroid hormone transport
Thyroid-binding globulin
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Most lateral, posterior extensions of thyroid tissue
Tubercles of Zuckerkandl
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Most sensitive indicator of thyroid function
TSH
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Portion of thyroid producing calcitonin
Parafollicular C cells
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Long term side effect of thyroxine treatment
Osteoporosis
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Tachycardia, fever, numbness, irritability, vomiting, diarrhea, high-output cardiac failure after stress in patients with undiagnosed thyroid disease
Thyroid storm
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Triggers for thyroid storm (4)
Surgery, anxiety, excessive gland palpation, adrenergic stimulants
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Treatment of thyroid storm (6)
Beta blockers, PTU, Lugol�s solution (KI), cooling, O2, glucose
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Giving patients in thyroid storm high doses of iodine to inhibit TSH action
Wolff-Chaikoff effect (Lugol�s solution given)
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Workup for asymptomatic nodule
Thyroid function tests, FNA, radionucleotide study
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Treatment of a hot nodule with indeterminant FNA
6 months of thyroxine, surgery if increases
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Treatment of a cold nodule with indeterminant FNA
Thyroidectomy/lobectomy
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Thyroid anomaly extending from isthmus toward thymus
Pyramidal lobe
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Thyroid tissue that persists in area of foramen cecum at base of tongue
Lingual thyroid
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Midline neck mass that moves upward with swallowing, susceptible to infection and premalignant in some cases
Thyroglossal duct cyst
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Surgical approach for thyroglossal duct cyst
Resection of cyst + hyoid bone
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Drug that inhibits peroxidases and prevents DIT and MIT coupling (2)
PTU, methimazole
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Side effects of PTU and methimazole
Cretinism in newborns (methimazole only), aplastic anemia, agranulocytosis
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Toxic diffuse goiter cuasing exophthalmos, pretibial edema, a fib, heat intolerance, thirst, appetite increase, weight loss, sweating, and palpitations
Grave�s disease
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Disease caused by IgG antibodies to TSH receptor
Grave�s disease
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Treatment of Graves (4)
Thionamides, radioactive iodine, subtotal thyroidectomy, total thyroidectomy
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Most common cause of thyroid enlargement
Toxic multinodular goiter
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Indications for surgery for toxic multinodular goiter
Suspicious nodule
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Treatment of single toxic nodule
Radioactive iodine, thionamdes, lobectomy if failure of medical management
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Most common cause of hypothyroidism in adults
Hashimotos disease
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Thyroid disease caused by autoimmune disease (antimicrosomal and antithyroglobulin antibodies)
Hashimoto�s disease
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Treatment of Hashimoto�s disease
Thyroxine, partial thyroidectomy if symptoms persist or compression occurs
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Disease with symptoms of viral URI, tender thyroid, sore throat, mass, weakness
DeQuervain�s thyroiditis
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Treatment of DeQuervain�s thyroiditis
Steroids and ASA, lobectomy if unilateral, total thyroidectomy for persistent inflammation
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Fibrous disease of carotid sheath and strap muscles adjacent to thyroid; can resemble cancer; can cause hypothyroidism and compressive symptoms
Riedel�s fibrous struma
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Treatment of Riedel�s fibrous struma
Steroids, thyroxine
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Most common endocrine malignancy in U.S.
Thyroid cancer
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Thyroid nodule characteristics suspicious for cancer (8)
Solid, solitary, cold, slow growing, hard, male>50, previous neck XRT, MEN 2a or 2b
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Most common thyroid cancer
Papillary
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Risk factor for papillary thyroid cancer
Childhood XRT, age >40-50
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Most common metastatic site for papillary thyroid
Lungs (overall rare)
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Pathologic characteristics seen frequently in papillary carcinoma
Psammoma bodies, orphan annie nuclei
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Patients needing radioactive iodine after removal of papillary thyroid cancer (4)
Metastatic disease, residual local disease, positive lymph nodes, capsular invasion
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Thyroid cancer that requires core/excisional biopsy for definitive diagnosis
Follicular
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Most common metastatic site for follicular carcinoma
Bone
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Indications for MRND in follicular carcinoma
Clinically positive nodes, extrathyroidal tissue involvement
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Indications for radioactive iodine following surgery for follicular carcinoma
Lesion >1cm, capsular invasion
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Typically the first manifestation of MEN2a and 2b
Medullary thyroid cancer
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Pathologic finding of medullary thyroid cancer
Amyloid
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Hormone secreted by medullary thyroid cancer; also used as a tumor marker
Calcitonin
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Symptoms of calcitonin release
Flushing, diarrhea
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Most common metastatic site for MTC
Lymph node, lung, liver, bone
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Treatment of thyroid in MEN 2a
Prophylactic thyroidectomy and central node dissection in childhood
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Treatment of thyroid in MEN 2b
Prophylactic thyroidectomy and central node dissection in infancy
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5-year survival of MTC
505
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Largely benign tumor of thyroid, although some are malignant and spread to bone, lung
Hurthle cell carcinoma
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Most aggressive thyroid cancer
Anaplastic
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Treatment of anaplastic thyroid cancer
Surgery if able, palliative thyroidectomy for compressive sx, palliative chemo and XRT
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Which thyroid cancers is radioactive iodine useful for?
Papillary, follicular
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Which thyroid cancers is XRT useful for?
All
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Side effects of radioactive iodine (6)
Sialoadenitis, GI symptoms, infertility, bone marrow suppression, parathyroid dysfunction, leukemia
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Drug given after radioactive iodine, to suppress TSH and slow metastatic disease
Thyroxine
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