Thyroid and Parathyroid Pathology Basic Guide

Lymphadenopathy - Lymph node or nodes lose ovoid appearance, becoming more rounded (increased ____ dimension) become hypoechoic, ____ normal fatty hilum appearance, have a random vascular pattern as opposed to a normal artery/vein entering the _____.

-AP -lose -hilum

The ____ purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very _____ range.

-ONLY -narrow

Thyroid size is usually ______ in women.

larger

The ______ thyroid hormone is Thyroxine (T4) 90%.

primary

____ _____ - extension of thyroid from isthmus cephalad as far as the hyoid bone.

pyramidal lobe

True cysts in the thyroid are ___.

rare

_____- any enlargement of the thyroid.

goiter

Thyroid Cancers: Follicular Carcinoma (Follicular ___________) · MC in females · Sonographic appearance: may have irregular tumor margins, thick and irregular halo and tortuous or chaotic arrangement of internal blood vessels. · Large (usually over 3cm) - Spoke & wheel pattern of color Doppler · US _______ differentiate from a benign follicular adenoma · Both are large, solid, well encapsulated with spoke & wheel vascularity · Histologic, not FNA cytologic analysis is necessary to pathologically diagnose · Metastasizes through bloodstream to distant sites (usually NOT to cervical lymph nodes) Medullary Carcinoma · Typically secretes the hormone _____ · Frequently familial. · Prognosis is _____ than for follicular. · Metastasis to cervical nodes · Hard bulky mass. · Similar sonographic appearance as papillary. · May be associated with MEN Syndrome (multiple endocrine neoplasia) Anaplastic · Disease of the ______ · Most ______ · Rapidly enlarging mass extending beyond the gland · Often associated with poorly differentiated papillary or follicular carcinomas. · Aggressive local invasion not so much to the lymph nodes. · Sonographic appearance: hypoechoic often seen to encase or invade blood vessels and neck muscles. · Usually better assessed by CT or MRI to completely evaluate extent and involvement of the large mass

-adenocarcinoma -cannot -calcitonin -worse -elderly -lethal

MCC of hyperparathyroidism is a single ______ usually less than 1cm but can be much larger.

-adenoma

Multinodular goiters · Made up of numerous _____/______/_____ within the thyroid gland. · These nodules have numerous sonographic appearances from solid to complex to cystic to honeycomb, from hypoechoic to hyperechoic · May or may not have some vascularity Non-Toxic goiters · ____________ · Diffuse enlargement, smooth and homogeneous. · Adenomas tend to develop over time. · Toxic Goiter · Diffuse enlargement · Decrease in overall echogenicity of the tissue. · Color Doppler demonstrates considerable increase in vascularity, referred to as the thyroid inferno. · Associated with ________ disease.

-adnomas/adenomatous/colloid -hypothyroidism -Graves

The strap and sternocleidomastoid muscles are ______ to the thyroid and the longus colli muscle is ______.

-anterior -posterior

Hyperthyroidism · Oversecretion of thyroid hormones. · Sometimes due to neoplasm (adenoma). · Weight loss, decreased _______, nervous energy, tremor, _____ intolerance, heart _______. · Possible Exophthalmus (protruding ________) · Associated with Graves' disease. · MC 30 to 40 · ______ hyperthyroidism is life-threatening- can cause cardiac, hepatic or renal failure.

-appetite -heat -palpitations -eyeballs -acute

A ______ _____ _____ is a type of birth defect in which a lump develops on one or both sides of your child's neck or below the collarbone. This type of birth defect is also known as a ____ _____ ______.

-branchial cleft cyst -brancial cleft remnant

Hyperparathyroidism · Increased function of the parathyroid gland. · MC in females, particularly after menopause, usually asymptomatic · Hyper______, elevated parathyroid hormone, hypercalciuria and low serum levels of phosphate. · 80-90% of cases are due to a single adenoma. · Manifestations are nephrolithiasis and osteopenia. Parathyroid tumors kill ______ (over a number of years), and if you have high PTH and calcium levels then it is very likely the parathyroid tumor is either directly ______ for the kidney failure, or it is making it much _____.

-calcemia -kidneys -responsible -worse

Psammoma bodies are round microscopic _____ collections.

-calcific

Hypothyroidism · Thyroid gland is not producing enough thyroid hormone. · Underactivity of the gland causes the ________ reactions of the body to _____ down. · Fatigue, weight gain, ______, hair loss, ______ ____, intolerance to ____, depression, hoarse and scratchy voice · MC women 40 to 50 · Patients usually have a ______ goiter. · Can be congenital. · Could be caused by pituitary gland. · Lack of _______ is mcc worldwide · Most patients take _______ ( a synthetic thyroid medication) to stabilize gland function to a normal range

-chemical -slow -constipation -flaky skin -cold -nontoxic -iodine -synthroid

Most ______ masses result from liquefactive degeneration of a benign hyperplastic nodule a.k.a. an adenomatous colloid nodule-characterized by comet-tail artifacts seen within the nodule, usually within the cystic portion. These type of nodules account for ____ of nodular disease. Basically colloid nodules are formed from liquefactive degeneration of an adenomatous/ademona nodule, and colloid nodules are most of the cystic masses seen in the thyroid.

-cystic -80%

Acute thyroiditis · Firm, painful, enlarged · Low-grade ____ Subacute thyroiditis · Aka de Quervain's or granulomatous thyroiditis · Similar symptoms as acute. · Often begins in one lobe and eventually migrates to the other. · Can last 2 to 5 months and can produce _______. Chronic thyroiditis · Aka _____ thyroiditis · Common in women 30 to 50 · Sonographic appearance- Acute- enlarged, hypoechoic, hypervascular. · Hypervascular-lights up like a Christmas tree. (_____) ·Chronic Stage-atrophied & hyperechoic, not much vascularity · MCC of _______ in the US

-fever -hyperthyroidism -hashimotos -inferno -hypothyroidism

Hypo vs hyper and Hashimotos vs Graves. ______ disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. ______ disease is an autoimmune disorder that can cause hypothyroidism, or underactive thyroid ____thyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally. _____thyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine.

-graves -hashimotos -hypo -hyper

Adenomas - represent 5-10% of thyroid nodular disease · 7 times more common in women. · Encapsulated by a hypoechoic ______. ______ adenomas are the MC type. Follicular adenomas are well encapsulated, usually solid, with a spoke & wheel _____ pattern. They ______ rather than replace normal thyroid tissue. Any nodule over _____ cm is usually biopsied.

-halo -follicular -vascular -displace -1.5 cm

So: Nontoxic goiter is associated with ______, toxic goiter is associated with _____ disease, and Chronic thyroiditis is aka with ________ thyroiditis.

-hypothyroidism -graves -hashimotos

The parotid glands, the _______ salivary glands, are found on each side of the face, just in front of the ____. About 7 out of 10 salivary gland tumors start here. Most of these tumors are benign (non-cancerous), but the parotid gland is still where most malignant (cancerous) salivary gland tumors start.

-largest -ears

Thyroiditis · Inflammation of the thyroid. · MC affects ___ -_____ women. · Diffuse enlargement · Hypoechoic

-middle-aged

Thyroglossal duct cyst; The cyst ______ when patient thrusts tongue in and out of mouth and usually has low level echoes (_____) within it.

-moves -debris

Lymphoma · Primarily the ____-_______ type. · Older females · ______ growing mass in the neck · May arise from a pre-existing Hashimoto's disease. · Sonographic appearance: nonvascular hypoechoic and lobulated mass, possibly large cystic necrosis within the tumor

-non-hodgkins -rapidly

_______ Carcinoma · Accounts for 75 to 90% of all thyroid cancers. · Occurs at any age, MC in females. · Very curable, even if it has spread to lymph nodes Sonographic Appearance · Solid, hypoechoic, sometimes single nodule · Microcalcifications - represent psammoma bodies. (only present in 35% of cases); vascular May have cervical lymph node metastasis May result from childhood radiation exposure

-papillary

_____ Hyperparathyroidism- (chronic hypocalcemia) is a serious disease of parathyroid glands characterized by ____ parathyroid hormone levels and _____ blood calcium. The parathyroid glands are overproducing parathyroid hormone in an attempt to help the body increase the amount of calcium in the blood. Parathyroid hormone is normally supposed to elevate blood calcium, calcitonin (thyroid) is normally supposed to lower it.

-secondary -high -low

The submandibular glands are _____ glands than the parotid and are found at the back of the _____. They secrete saliva under the tongue area. About 1 or 2 out of 10 tumors start in these glands, and about half of these tumors are benign.

-smaller -jaw

The sublingual glands, which are the _____, are found ______ the floor of the mouth and below either side of the ______. Tumors starting in these glands are ____.

-smallest -under -tongue -rare

Worrisome Malignant characteristics of thyroid- _____, vascular, _____ ____echoic nodule,

-solid -single -hypo

All neck ultrasounds should include _______ _______ and ___ _____ _______ (unless facility/radiologists are against it).

-submandibular glands -lymph node chains

1) Thyroxine (T4 or __________) · Most ______ thyroid hormone · Stimulates consumption of ______ · Secreted by the follicular cells of the thyroid

-tetraiodothyronine -abundant -oxygen

Graves'Disease · Toxic goiter · Bulging of the eyes.- Exophthalmus · Skin _______ · Autoimmune disorder. · Hyperthyroidism

-thickening

Thyrotropin- aka-Thyroid Stimulating Hormone (TSH)· Secretion controlled by the ____ ____ ______.

anterior pituitary gland

The comet tail artifacts in colloid nodules are ______ from psamoma bodies. Be careful differentiating calcifications of psammoma bodies versus comet-tail artifacts from benign adenomatous colloid nodule

different