Lesson 1E (Part 2)

Question 1

Toxic nodular goitre

Answer 1

One or two nodules of a gland that is already affected by goitre become active and secrete excess T3and T4

Question 2

What does toxic nodular goitre cause?

Answer 2

Effects of hyperthyroidism

Question 3

Who is toxic nodular goitre more common in?

Answer 3

Women

- after middle age (older than graves disease)

Question 4

What is more common in the older age group than toxic nodular goitre? (2)

Answer 4

1. Arrhythmias

2. Cardiac failure

Question 5

What is another name for autoimmune thyroiditis?

Answer 5

Hashimotos disease

Question 6

What is the most common cause of acquired hypothyroidism?

Answer 6

Hashimotos disease

Question 7

Who is hashimotos disease more common in?

Answer 7

Women

Question 8

Autoimmune thyroiditis

Answer 8

Organ-specific autoimmune condition

- goiter sometimes present

Question 9

What are the characteristic sonographic patterns of hashimotos thyroiditis? (4)

Answer 9

1. Diffusely coarse echotexture
2. Innumerable tiny hypoechoic nodules that may become confluent
3. Interspersed with echogenic fibrous bands
4. Vascularity
   - increase, decreased or normal

Question 10

Confluent

Answer 10

Run together

Question 11

What are 2 other names for an adenoma?

Answer 11

1. Colloid

2. Adenomatous nodule

Question 12

Adenoma

Answer 12

Hyperplastic nodule

Question 13

What is the most common lesion in the thyroid?

Answer 13

Adenoma

Question 14

What is the sonographic appearance of an adenoma?

Answer 14

1. Isoechoic
   - but can also be hypoechoic
2. Commonly undergo cystic and hemorrhagic degeneration
3. Larger solid masses may be entirely echogenic
4. Degeneration of hyperplastic nodules
   - dystrophic calcification = either coarse internal calcification or peripheral ‘‘eggshell’’ calcification

Question 15

Goiter

Answer 15

Enlargement of the thyroid gland without signs of hyperthyroidism

Question 16

What is goiter caused by?

Answer 16

A relative lack of T3and T4

Question 17

What do low levels of T3 and T4 stimulate?

Answer 17

Secretion of TSH resulting

Question 18

What does stimulating of TSH result in?

Answer 18

Hyperplasia of the thyroid gland

Question 19

Hyperplasia

Answer 19

The enlargement of an organ or tissue caused my an increase in the reproduction rate of its cell

Question 20

What develops when you have hyperplasia of the thyroid gland?

Answer 20

Hypothyroidism

Question 21

What are causes of goiter? (3)

Answer 21

1. Persistent iodine deficiency
   - dietary iodine deficiency (endemic goitre)
2. Genetic abnormality affecting synthesis of T3and T4
3. Iatrogenic
   - e.g. antithyroid drugs, surgical removal of excess thyroid tissue

Question 22

What can enlarged glands cause from goiter?

Answer 22

Pressure damage to adjacent tissues

Question 23

What structures are most commonly effected from goiter? (3)

Answer 23

1. Oesophagus
   - dysphagia (hard to swallow)
2. Trachea
   - dyspnoea (hard to breath)
3. Recurrent laryngeal nerve
   - hoarseness of voice

Question 24

What kind of nodules do you get from goiter?

Answer 24

Multinodular

• very common
• multiple hyperplastic nodules with varying degrees of colloid, necrosis, or hemorrhage
• multiple masses of varying size and echo texture***

Question 25

What kind of echotexture does goiter have?

Answer 25

Heterogeneous

Question 26

How common are malignant tumours of the thyroid gland?

Answer 26

They are rare

Question 27

What is the only well established risk factor for differentiated thyroid cancer ?

Answer 27

External head and neck radiation

- especially during infancy

Question 28

What is the most common thyroid malignant tumour?

Answer 28

Papillary cancer

- 75-80% of thyroid cancers

Question 29

What are sonographic findings of papillary cancer? (4)

Answer 29

1. Punctuate, non-shadowing echogenic foci
   - microcalcifications
2. Solid **
3. Hypoechoic **
4. Intrinsic vascularity **