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
