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Flashcards in ENDOCRINE Deck (63)
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1

FNA not sensitive to identify

not sensitive to identify lymphoma

not sensitive to follicular thyroid
malignancies

2

If FNA is negative,

must repeat with US or open biopsy

Tru cut biopsy can be performed but FNA is preferred

3

new test to screen individuals suspected of papillary
thyroid cancer.

RET proto-oncogene is a new test to screen individuals suspected of papillary
thyroid cancer. Test is not available in all centers

4

evidence of dysphonia or vocal cord
involvement

Indirect laryngoscopy is done if there is

5

when is External radiation is administered for thyroid cancer

when there is a large malignant thyroid mass


6

When thryoid metastases occur they first go to

neck nodes,
bones,
liver,
brain

7

factors that suggest a malignant thyroid like

age 70,
male sex, associated with dysphagia or dysphonia, prior radiation, firm hard nodule,

8

medullary thyroid cancer what is most important part of evaluation

r/o MEN

9

Most patients who have an incidental adrenal mass have no symptoms when they do have sx what may they be


o Non-functional masses:
fever,
weight loss,
abdominal pain,
back pain,
bdominal fullness

o Functional tumors:
Cushing syndrome
Virilization syndromes
Precocious puberty
Amenorrhea
Facial acne
Hypo or hyper-aldosteronism

Adrenal Carcinoma
Cachexia
Conn syndrome

10

screening for adrenal incidentaloma


o Should screen for excess hormone production:

corticosteroids and appropriate suppression tests

aldosterone
adrtogen
estradiol
catecholamines (metanephrines) plasma / urine

11

Imaging Considerations adrenal incidentaloma

CT and MRI are equally
good to visualize adrenal mass


CT
attuenuation values :
higher than 20 are thought to be related to malignant mass

12

Aldo to renin ratio of what to dx conns

greater than 20

13


biochemical workup for patient who does not have a clear diagnosis of primary hyperparathyroidism (PHPT)

chloride:phosphate (Cl:PO4) ratio greater than 33 lends further support to the diagnosis.

ionized calcium,
creatinine,
albumin,
25-OH Vitamin D levels



Vitamin D deficiency is common in the setting of PHPT and warrants replacement, because increased parathyroid hormone (PTH) results in increased clearance and degradation of Vitamin D.

A 24-hour urine collection for calcium and creatinine may also be indicated to exclude a renal calcium leak causing a secondary rise in PTH.



14

Patients with bilateral idiopathic hyperaldosteronism are treated with

selective
and nonselective mineralocorticoid receptor blockers


15

Indications for performing. Thyroidectomy in asymptomatic patients

Patients Who Meet ONE or More Guidelines Should Be Referred for Surgery.

LESS than age 50

Serum calcium (above upper limit of normal) 1.0 mg/dL

Renal function GFR

16

Ssx to ask about for w/u of thyroid cancer

B symptoms

voice changes
dysphagia

if concerened - laryngoscopy

CT head and neck if concern

17

If nodes positive on papillary

total

central neck

AND

modified radical

18

risk of caner if path comes back follicular neoplasm

20%

(unless patient presents with local invasion symptoms)

19

symptomatic hypocalcium

in hospital with IV calcium

20

tricky lab to get on thyroid cancer in pregnant

DNA mutation analysis

if negtive you can watch thryoid cancer

21

normal PTH

Normal values are 10 to 55 picograms per milliliter (pg/mL).

expect 50% decrease intra op at 10 mins post excision

22

Approach if parathyroid hormone does not drop after you remove abnormal gland

Explorer ALL three other parathyroid's

Then start by taking out the most abnormal looking gland and redraw calcium

23

If all parathyroid glands look normal

Biopsy them to make sure that they are in fact all parathyroid's

Because finding the fourth gland easier then finding a supernumerary fifth gland(Which is most common sinus)

24

What is the dose of calcium gluconate

10% and 10 mL give never 10 minutes

Alternative 30 mg IV

25

Where is the management of a follicular me a pleasant in a pregnant woman

Can watch

(if you want to be fancy you could do a DNA mutation study)

26

Concern of a large lymph node when doing your hammy thyroidectomy for follicular and neoplasm

Frozen will not help

Because follicular neoplasm and you need to see if there is capsular invasion

27

What is the potential utility of having a TSH level when working at suspected thyroid cancer

TSH is trophic for the thyroid

28

What is typical pathology report follicular and neoplasm

Scant follicular
Rare intranuclear inclusions

This is really nondiagnostic

29

Diffuse goiter

(Grave's disease)

"HYPER about going to the grave with bug eyes"

most common in USA,

enlarged gland

exophthalmoses

positive LATS (antibodies) level in the blood.

30

Nodular goiter

"HYPER big nodules"

multi nodular goiter

Plummer Disease

most common cause of hyperthyroidism overseas,

Uni-nodular

nodule> 3 cm

rare cause of HYPERthyroidism)