Chapter 12: Neck (Penny)

thyroid inferno

sonographic appearance of hypervascularity demonstrated with color doppler imaging of the thyroid gland

anechoic, well-defined, and unilocular cyst with posterior enhancement

sonographic findings of a thyroglossal duct cyst

isthmus

there is a bridge of tissue known as __________ that connects the 2 lobes of the thyroid. it crosses over the midline of the neck anterior to the trachea.

thyroid-stimulating hormone (TSH)

thyroid releasing hormone controls the release of __________ by the anterior pituitary gland

c. colloid

17. The fluid produced by the thyroid gland that contains thyroid hormones is referred to as: a. thyroxine b. calcitonin c. colloid d. triiodothyronine

b. iodine

19. The thyroid gland utilizes which of the following to produce its hormone? a. colloid b. iodine c. iron d. calcium

a. cold nodule

4. Which of the following would more likely be a malignant thyroid nodule? a. cold nodule b. hot nodule

d. calcium

5. Parathyroid glands control the release and absorption of which nutrient? a. thyroxine b. triiodothyronine c. calcitonin d. calcium

d. 10 mm

6. A normal lymph node will not measure greater than: a. 8 mm b. 5 mm c. 12 mm d. 10 mm

b. echogenic hilum

14. All of the following are sonographic findings of an abnormal lymph node except: a. rounded shape b. echogenic hilum c. calcifications d. enlargement

hashimoto thyroiditis sono: mild enlargement of the thyroid. hypervascular gland, heterogeneous.

Autoimmune disorder that is the most common cause of hypothyroidism in US.

1. elevated serum calcium 2. elevated PTH

Clinical findings of parathyroid adenoma

1. bulging eyes 2. heat intolerance 3. nervousness 4. weight loss 5. hair loss

Clinical signs of grave's disease

metabolism

Each hormone is vital and work together to regulate _________, growth, development, and activity of nervous system

2 pairs or sometimes a 5th gland is present

How many parathyroid glands do we have?

superior and lateral; medial

Jugular veins are located ______ and ______ to the CCA. the CCA is more __________

homogeneous medium to high level echogenicity (similar to testes)

Normal thyroid tissue has what echotexture?

1. mild enlargement 2. heterogeneous echotexture 3. hypervascular gland

Sono findings of hashimoto

hypoechoic mass adjacent to the thyroid

Sonographic findings of parathyroid adenoma

hyperthryoidism or hypothyroidism

Surplus in T4 or T3 will produce:

Strap muscles (sternohyoid, sternothyroid, omohyoid) sternocleidomastoid muscles longus colli muscles CCA IJV esophagus

Surrounding muscles and vascular structures of the thyroid

esophagus

Surrounding muscles and vascular structures of the thyroid: most often seen on the left side posterior to the trachea and thyroid

abundant

T4 (thyroxine) is the most ________ hormone produced by the thyroid

2

The thyroid has how many lobes?

True

True or False. The arteries that feed the thyroid are the superior thyroid artery and inferior thyroid artery.

right lobe

Which lobe of the thyroid is usually larger?

neoplasm

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

pyramidal lobe

a normal variant to the thyroid gland in which there is a superior extension to the isthmus

high frequency linear transducer

a thyroid sonogram is performed with a

branchial cleft cyst

benign congenital cyst located near the angle of the mandible

thyroglossal duct cysts

benign congenital cysts located within the midline of the neck superior to the thyroid gland and near the hyoid bone

iodine deficiency grave's disease thyroiditis

causes of goiters

palpable neck mass located near the angle of the mandible

clinical finding of branchial cleft cyst

1. depression 2. increased cold sensitivity 3. elevated blood cholesterol levels 4. slight weight gain may occur

clinical findings of hashimoto

palpable mass within the midline of the neck superior to the thyroid gland

clinical findings of thyroglossal duct cyst

chronic autoimmune lymphocytic thyroiditis

hashimoto thyroiditis is AKA

c. too few thyroid hormones

18. In the presence of Hashimoto thyroiditis, the thyroid produces: a. too many thyroid hormones b. too much calcium c. too few thyroid hormones d. too much iodine

b. 4

2.Normally, how many parathyroid glands are found within the adult neck? a. 3 b. 4 c. 6 d. 8

d. 10 mm

24. A thyroid isthmus that measures greater than ____ is indicative of thyroid enlargement. a. 8 mm b. 5 mm c. 12 mm d. 10 mm

a. thyroxine

28. Which of the following is the hormone that is the most abundantly produced by the thyroid? a. thyroxine b. iodine c. triiodothyronine d. calcitonin

a. endocrine

29. What type of gland is the thyroid gland? a. endocrine b. exocrine c. both a and b d. neither a nor b

a. brachial cleft cyst

3. A cystic mass noted at the mandibular angle is most likely a: a. brachial cleft cyst b. follicular adenoma c. thyroglossal duct cyst d. parathyroid adenoma

b. graves disease

9. Which abnormality is associated with the sonographic findings of a thyroid inferno? a. hashimoto thyroiditis b. graves disease c. hyperparathyroidism d. cervical lymphadenopathy

goiter

enlarged, hyper plastic thyroid gland

cervical lymphadenopathy

enlargement of the cervical lymph nodes

colloid

fluid produced byt the thyroid that contains thyroid hormones

hypo-functioning

nuclear medicine terminology for cold nodule:

follicular carcinoma, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastases

other forms of malignant thyroid nodules include

parathyroid hormone, PTH

parathyroid glands control the release and absorption of calcium by producing

calcitonin

responsible for removing calcium from the blood for storage in the bones

within the brain

the hyhpothalamus is located

thyroid-releasing hormones

the hypothalamus produces

parathyroid adenoma

the most common cause of enlargement of the parathyroid gland

endocrine

the thyroid is a ____ gland

iodine

the thyroid uses ______ to manufacture these hormones

thyroglossal duct cysts

benign congential cysts located within the midline of the neck superior to the thyroid gland and near the hyoid bone

Strap muscles (sternohyoid, sternothyroid, omohyoid)

Surrounding muscles and vascular structures of the thyroid: anterior to each lobe

CCA, IJV, sternocleidomastoid muscle

Surrounding muscles and vascular structures of the thyroid: lateral to each lobe

longus colli muscle

Surrounding muscles and vascular structures of the thyroid: posterior to each lobe

thyrocervical

The inferior thyroid artery is a branch of the ___________ trunk of the subclavian artery

1st

The superior thyroid artery is the ________ branch of the ECA

parathyroid glands commonly located posteriormidportion. they are calcium regulators for the body.

This gland serves as calcium regulation for the body

superior thyroid vein and inferior thyroid vein (corresponding veins to the arteries drain into the internal jugular vein)

What 2 venous structures drain into the IJV to drain the thyroid?

this is used to determine whether the thyroid nodules are hyper or hypofunctioning.

What is the purpose of scintigraphy?

end of 1st trimester

When does the thyroid become fully functional?

3rd week of gestation

When does the thyroid develop?

1-posterior aspect of mid portion of each lobe 1- inferior to each lobe

Where are the parathyroid glands located?

1. extensive cystic components 2. cysts < 5mm 3. eggshell calcifications 4. "Hot" nodule (nuclear medicine finding)

benign thyroid nodule characteristics

hyperplastic nodules

benign thyroid nodules are considered to be follicular adenomas or ________ __________

hyperthyroidism

condition that results from the overproduction of thyroid hormones

hypocalcemia; hypercalcemia

decreased levels of serum calcium levels are indicative of _______ and increased levels of serum calcium are indicative of ___________

thyroglossal duct

embryonic duct that is located from the base of the tongue to the mid portion of the anterior neck

c. parathyroid adenoma

7. Hypercalcemia is associated with which of the following? a. grave's disease b. thyroglossal duct cyst c. parathyroid adenoma d. thyroid adenoma

hypothyroidism

condition that results from the underproduction of thyroid hormones

IJV and CCA

two prominent structures seen lateral to the thyroid gland

a. a hypoechoic, oblong structure with a distinct echogenic hilum

8. Which of the following best describes the normal appearance of a cervical lymph node? a. a hypoechoic, oblong structure with a distinct echogenic hilum b. a rounded, echogenic structure with small calcifications c. a solid, hypoechoic mass that measures greater than 1 cm d. a solid, echogenic mass that measures less than 1 cm

c. thyroglossal duct cyst

1. Benign congenital cysts located superior to the thyroid gland and near the hyoid bone are referred to as: a. brachial cleft cysts b. follicular adenomas c. thyroglossal duct cyst d. parathyroid adenomas

b. echogenic mass

10. All of the following are sonographic findings of malignant thyroid nodules except: a. internal calcifications b. echogenic mass c. cervical node involvement e. solitary mass

d. cold nodule

11. All of the following are diagnostic findings of benign thyroid nodules except: a. anechoic mass b. eggshell calcification c. hyperechoic mass d. cold nodule

d. papillary

12. Which of the following is the most common form of thyroid cancer? a. follicular b. anaplastic c. lymphoma d. papillary

b. hashimoto thyroiditis

13. What is the most common cause of hypothyroidism? a. graves disease b. hashimoto thyroiditis c. papillary carcinoma d. parathyroid adenoma

a. graves disease

15. What is the most common cause of hyperthyroidism? a. graves disease b. hashimoto thyroiditis c. papillary carcinoma d. parathyroid adenoma

T4 (thyroxine) and T3 (triiodothyronine)

aids in the metabolism of fats, proteins, and carbs

10mm

an isthmus of greater than ______ mm is indicative of thyroid enlargement

anechoic mass near the angle of the mandible

sonographic finding of a branchial cleft cyst

1. heterogeneous echotexture 2. may contain nodules with cystic and solid components

sonographic finding of goiter

1. enlargement of the node > 1cm 2. rounded shape 3. loss of the echogenic hilum 4. calcifications

sonographic findings of cervical lymph nodes

1. enlarged gland 2. heterogeneous or diffusely hypoechoic echotexture 3. thyroid inferno

sonographic signs of graves disease

b. Grave's disease

16. A 30-year-old patient presents to the ultrasound department for a thyroid sonogram with a history of weight loss, hair loss, and hyperthyroidism. You note that the patient has bulging eyes. What is the most likely diagnosis? a. Hashimoto thyroiditis b. Grave's disease c. hyperparathyroidism d. cervical lymphadenopathy

b. longus colli

20. Which muscles are located posterior to each thyroid lobe? a. sternocleidomastoid b. longus colli c. sternohyoid d. omohyoid

a. sternocleidomastoid

21. Which muscles are located lateral to each thyroid lobe? a. sternocleidomastoid b. longus colli c. sternohyoid d. omohyoid

a. esophagus

22. What structure may be confused for a thyroid or parathyroid mass because of its relationship to the trachea and the posterior aspect of the left thyroid gland? a. esophagus b. common carotid artery c. internal jugular vein d. sternothyroid

d. ICA

23. Which vascular structure is located closest to the thyroid lobes? a. external carotid vein b. external carotid artery c. IJV d. ICA

d. strap

25. Which muscles are located anterior to the thyroid gland? a. sternocleidomastoid b. longus colli c. thyrocervical trunk d. strap

c. superior thyroid artery

26. What is the first branch of the external carotid artery? a. ICA b. optic artery c. superior thyroid artery d. inferior thyroid artery

b. iodine

27. All of the following are hormones produced by the thyroid except: a. thyroxine b. iodine c. triiodothyronine d. calcitonin

d. pyramidal lobe

30. The superior extension of the thyroid isthmus is referred to as: a. thyroglossal duct b. brachial cleft c. yodeler's lobe d. pyramidal lobe

fine needle aspiration (FNA)

highly efficient way to determine the character of clinically or sonographically identifiable thyroid nodules. low risk procedure, minimally invasive, tissue is numbed, and small needle inserted into the nodule with the use of ultrasound.

1. hypoechoic mass 2. mass with internal micro calcifications 3. solitary mass 4. enlargement of the cervical lymph nodes (metastasis) 5. "Cold" nodule (nuclear med finding)

malignant characteristics of thyroid nodules

4 to 6 cm in length 2-3 cm in width 1-2 cm in thickness isthmus 2-6 mm AP diameter

measurements of the thyroid and isthmus

follicular adenomas

most common benign thyroid neoplasm and have a wide range of sonographic appearance

Grave's disease

most common cause of hyperthyroidism

5.0 x 3.0 x 1.0 mm

normal parathyroid measurements:

scintigraphy

nuclear medicine in which a radiopharmicutical is used to examine the thyroid gland.

hyper-functioning

nuclear medicine terminology for hot nodule:

thyroxine; T4. triiodothyronine; T3. and calcitonin.

thyroid stimulating hormone makes the thyroid release

papillary carcinoma

the most common form of thyroid cancer

benign thyroid nodules

the most common masses found within the thyroid