Ch. 22 Thyroid and Parathyroid Glands

Name the Pathology -occurs when the serum PTH level is increased due to chronic hypocalcemia -not caused by a disfunction of the parathyroid gland -stimulated by compensatory reaction hypocalcemia

secondary hyperparathyroidism

There are two types of follicular carcinoma what are they?

-minimally invasive/ well encapsulated, focal invasion of blood vessels. -widely invasive/ not encapsulated, tumor blood vessels invade surrounding thyroid tissue

PTH acts on several target organs ____, ____, ____ to increase calcium absorption into the blood.

-skeletal system -kidneys -intestines

What is the major route of spread of papillary carcinoma?

-through the lymphatic system (to the cervical lymph nodes)

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

a. Esophagus

What is the most common cause of hyperthyroidism? a. Graves disease b. Hashimoto thyroiditis c. Papillary carcinoma d. Parathyroid adenoma

a. Graves disease

Which muscles are located lateral to each thyroid lobe? a. Sternocleidomastoid b. Longus colli c. Sternohyoid d. Omohyoid

a. Sternocleidomastoid

Which of the following is the hormone that is the most abundantly produced by the thyroid? a. Thyroxine b. lodine c. Triiodothyronine d. Calcitonin

a. Thyroxine

What is the most common cause of primary hyperparathyroidism?

adenoma

Which muscles are located posterior to each thyroid lobe? a. Sternocleidomastoid b. Longus colli c. sternohyoid d. omohyod

b. longus colli

Which of the following is the most common form of thyroid cancer? a. Follicular b. Anaplastic c. Papillary

c. papillary carcinoma

____ plays a minor role to regulate blood calcium levels.

calcitonin

The parathyroid glands are considered the ____ sensing organs of the body.

calcium

T3 and T4 stimulate ____ ____.

cell metabolism

The thyroid is the ____ endocrine gland to develop in the human embryo.

first

General enlargement of the thyroid gland is called?

goiter

The most common cause of thyroid malignancy is _____________ carcinoma. a. papillary b. medullary c. anaplastic d. follicular

ANS: A Approximately 90% of thyroid malignancies are papillary carcinomas and are found more often in women and metastasizes to the cervical nodes in approximately 20% of patients.

_____ cells are the only ones that can absorb iodine.

follicular

The lobes of the thyroid gland are connected by: a. ismal tissue. b. the isthmus. c. island tissue. d. parathyroid tissue.

ANS: B A thin bridge of thyroid tissue connects the two thyroid lobes and is called the isthmus.

The most common cause of primary hyperparathyroidism is which one of the following? a. Thyroid adenoma b. Parathyroid adenoma c. Parathyroid cyst d. Parathyroid hemorrhagic cyst

ANS: B Parathyroid adenoma is the most common cause of primary hyperparathyroidism (80% of patients).

The parathyroid glands produce a hormone that affects the: a. liver, colon, and kidneys. b. kidneys, bones, and gastrointestinal tract. c. gastrointestinal tract, breast, and scrotum. d. kidneys, heart, and colon.

ANS: B Parathyroid glands produce parathyroid hormone (PTH), which acts on the bone, kidney, and intestine to enhance calcium absorption.

What are the three thyroid hormones?

-Triiodothyronine (T3) -Thyroxine (T4) -Calcitonin

Name the Pathology -benign -7x more in females -solitary and slow growing -has euthyroid -hypoechoic halo

adenoma

The fluid produced by the thyroid gland that contains thyroid hormones is referred to as: a. Thyroxine b. Calcitonin c. Colloid d. Triiodothyronine

c. Colloid

Hypercalcemia is associated with which of the following? a. Graves disease b. Thyroglossal duct cyst c. Parathyroid adenoma d. Thyroid adenoma

c. Parathyroid adenoma

The parathyroid glands are ____ organs normally located on the ____ surface of the thyroid gland.

-endocrine -posterior

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. Cold nodule

Name the Pathology -derives from the parafollicular/c-cells -calcitonin will be elevated -large calcium deposits -not associated w/ chest & neck radiation -associated with multiple endocrine neoplasia (2 types)

medullary carcinoma

Follicular carcinoma metastasized to what organs?

-bone -brain -lung -liver

The thyroid gland is made up of 2 types of cells, what are they?

-follicular -parafollicular

Approximately 80% of nodular thyroid diseases is due to ____ or compensatory ____ forming micro-nodules & macro-nodules of the gland.

-hyperplasia -hypertrophy

Which one of the following structures lies medial to the left thyroid lobe? a. Larynx b. Jugular vein c. Strap muscles d. Longus colli muscle

ANS: A The larynx, trachea, inferior constrictor of the pharynx, and esophagus are located medial to the left thyroid lobe.

The approximate dimensions of the thyroid gland are: a. 5 cm length, 2 cm width, 2 cm depth. b. 4 cm length, 5 cm width, 2 cm depth. c. 3 cm length, 5 cm width, 2 cm depth. d. 6 cm length, 3 cm width, 3 cm depth.

ANS: A The normal adult thyroid measures 4 to 6 cm in length, 1.5 to 2.0 cm in width, and 2 to 3 cm in depth (anteroposterior diameter).

The thyroid gland develops at the floor of which structure? a. Primitive pharynx b. Trachea precursor c. Maxilla d. Nasopharynx

ANS: A The thyroid gland develops at the floor of the primitive pharynx at the same location of the base of the tongue. The developing thyroid gland migrates inferiorly along the anterior neck region to the lower neck anteriorly to the trachea.

The pyramid lobe of the thyroid gland extends from the __________________. a. superior right lobe b. inferior left lobe c. superior isthmus d. inferior right lobe

ANS: C A pyramid lobe extends from the superior isthmus in 15% to 30% of patients.

A solitary thyroid nodule in the presence of ipsilateral lymphadenopathy suggests which one of the following? a. Adenoma b. Grave's disease c. Follicular carcinoma d. Hashimoto's thyroiditis

ANS: C A solitary thyroid nodule in the presence of ipsilateral lymphadenopathy suggests a follicular carcinoma.

A ___________ is a palpable anterior midline mass between the hyoid bone and the isthmus of the thyroid gland. a. carotid aneurysm b. parathyroid adenoma c. thyroglossal duct cyst d. brachial cleft cyst

ANS: C A thyroglossal duct cyst is a congenital anomaly that appears in the midline of the neck, anterior to the trachea.

Which one of the following sonographic features of a thyroid adenoma is the most common? a. Complex echo pattern b. Hyperechoic mass c. Hypoechoic peripheral halo d. Irregular margins

ANS: C Adenomas have a broad spectrum of ultrasound appearances with a relatively consistent hypoechoic peripheral halo.

Which one of the following structures lies posterolateral to the thyroid gland? a. Esophagus b. Sternocleidomastoid muscle c. Longus colli muscle d. Omohyoid muscle

ANS: C Structures lying posterolateral to the thyroid gland include the carotid sheath (carotid artery, internal jugular vein, and vagus nerve) and the longus colli muscle.

The most common cause of thyroid disorders worldwide is which one of the following? a. Hypothyroidism b. Iron deficiency c. Iodine deficiency d. Autoimmune process

ANS: C The most common cause of thyroid disorders worldwide is iodine deficiency, which leads to goiter formation and hypothyroidism.

An abnormal lymph node demonstrates which one of the following? a. Homogeneous texture b. Central echogenic complex c. Oval contour d. Round contour

ANS: D The more round the lymph node, the more likely it is malignant.

The normal parathyroid glands are located on the ____________ and the ____________ surface of the thyroid gland. a. posterior; lateral b. anterior; lateral c. anterior; medial d. posterior; medial

ANS: D The parathyroid glands are normally located on the posteromedial surface of the thyroid gland.

Name the Pathology -painless -most common form of thyroiditis -young middle aged women -low T3 & T4 but high TSH -micro-nodules -destructive immune system -pseudolobules

Hashimotos

What is the first branch of the external carotid artery? a. Internal carotid artery b. Optic artery c. Superior thyroid artery d. Inferior thyroid artery

c. Superior thyroid artery

Name the Pathology increased appetite irritable heat intolerance impaired infertility high degree of nervousness weight loss sweating palpitation exophthalmos most common form is graves disease

hyperthyroidism

parathyroid glands superior glands develop where?

primitive pharyngeal, migrant inferiorly

Name the Pathology -caused by viral infection -VERY PAINFUL -transient hyperthyroidism -fever -enlargement -malaise

subacute de Quervain's thyroiditis

Name the Pathology -most common cause of primary hyperparathyroidism -usually oval and solitary -surgical removal is the only definitive treatment -oval, hypo, homo, solid

parathyroid adenoma

Normally, how many parathyroid glands are found within the adult neck?

4

A cystic mass noted at the mandibular angle is most likely a: a. Branchial cleft cyst b. Follicular adenoma c. Thyroglossal duct cyst d. Parathyroid adenoma

a. Branchial cleft cyst

Which of the following would more likely be a malignant thyroid nodule? a. Cold nodule b. Hot nodule

a. Cold nodule

Where does the thyroid store its hormones?

colloid material

The superior extension of the thyroid isthmus is referred to as the: a. Thyroglossal duct b. Branchial cleft c. Yodeler's lobe d. Pyramidal lobe

d. Pyramidal lobe

Which muscles are located anterior to the thyroid gland? a. Sternocleidomastoid b. Longus colli c. Thyrocervical d. Strap

d. Strap

Name the Pathology May affect large groups of people in a specific geographic area where iodine levels in food & water are low.

endemic goiter

Where are the parathyroid glands derived from?

endoderm cell tissue

Name the Pathology -comprises 70% of all thyroid cancers -high vascularity -least aggressive -females affected 3x more -between 20-40 years -w/ chest and neck radiation -spreads thru lymphatics -ill defined borders -taller than wide micro-calcification

papillary carcinoma

Name the Pathology -most common thyroid malignancy -comprises 70% of all thyroid cancers -least aggressive -females affected 3x more -usually seen around 20-40 yo -solid texture hypoechoic compared to strap muscles -"taller than wide" internal micro-calcifications -increased vascularity

papillary carcinoma

Name the Pathology -not caused by dysfunction of the parathyroid gland -due to chronic hypocalcemia

secondary hyperparathyroidism

Which of the following best describes the normal appearance of a cervical lymph node? а. 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

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

The thyroid metastasis from: (3)

-breast -RCC -melanoma

Every ____ in the body depends on thyroid hormones for regulation of their ____.

-cell -metabolism

normal mean volume thyroid volume is ____?

10-12 ± 3 ml

Normal size of parathyroid glands?

5 x 3 x 1 mm

Microcalcifications are present in ____% to ____% of thyroid carcinoma.

50-80%

____% to ____% of micro calcifications are present in thyroid carcinoma.

50-80%

Name the Pathology -rare -undifferentiated -many years after radiation -considered most deadly -2x more common in men -60 y/o -dyspnea -dysphagia -hoarseness -cough

Anaplastic carcinoma

Name the Pathology -autoimmune disorder -thyroid inferno -immune system attacks thyroid gland and causes high of T3 & T4 -triad clinical findings >hypermetabolism >diffuse toxic goiter >exophthalmus -most common cause of hyperthyroidism thickening of the dermis

Grave's Disease

hypothyroidism is also called

Myxedema

What thyroid cancer are associated with neck and chest radiation and which are not?

RADIATION -papillary -anaplastic NOT ASSOCIATED WITH RADIATION -follicular -medullary

Which thyroid hormone is more potent?

T3 (triiodothyronine)

Which thyroid hormones is the most abundant?

T4 (Thyroxine)

Uncontrolled acute hyperthyroidism may cause a severe complication of graves disease called?

Thyrotoxicosis

What type of gland is the thyroid gland? a. Endocrine b. Ехоcrine c. Both A and B d. Neither A nor B

a. Endocrine

All of the following are hormones produced by the thyroid except: a. Thyroxine b. lodine c. Triiodothyronine d. Calcitonin

b. lodine

The thyroid gland utilizes which of the following to produce its hormones? a. Colloid b. lodine c. Iron d. Calcium

b. lodine

Benign congenital cysts located superior to the thyroid gland near the hyoid bone are referred to as: a. Branchial cleft cysts b. Follicular adenomas c. Thyroglossal duct cysts d. Parathyroid adenomas

c. Thyroglossal duct cysts

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

c. Too few thyroid hormones

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

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

d. 10 mm/1 cm

5. Parathyroid glands control the release and absorption of which nutrient? a. Thyroxine (T4) b. Triiodothyronine (T3) c. Calcitonin d. Calcium

d. Calcium

Which vascular structure is located closest to the thyroid lobes? a. External carotid vein b. External carotid artery c. Internal jugular vein d. Internal carotid artery

d. Internal carotid artery

What is the most common cause of thyroid disorders?

iodine deficiency

thyroid volume formula

l x w x h x .52

Name the Pathology -most common form is non-hodgkins -affects older females 4x more -in most cases patient has preexisting lymphatic thyroiditis -non vascular

lymphoma

A solitary hypoechoic thyroid nodule with the presence of cervical lymphadenopathy on the same side suggest what?

malignancy

Name the Pathology -mets to lymph nodes must be present to diagnose -f=m -high serum calcium -most rare cause for hyperparathyroidism

parathyroid carcinoma

Name the Pathology -mets to lymph nodes must be present to diagnose -f=m -high serum calcium -most rare cause for primary hyperparathyroidism

parathyroid carcinoma

The parathyroid glands produce ____ to control the serum calcium concentration using a feedback mechanism.

parathyroid hormone (PTH)

Name the Pathology -more common after age 40 -affects women more -abnormal secretion of PTH which signals more calcium to be released -could be cause by an adenoma, parathyroid hyperplasia, or carcinoma of the parathyroid glands

primary hyperparathyroidism

A nuclear medicine test called ____ ____ ____ is often completed to try to locate abnormally functioning parathyroid glands.

sestamibi parathyroid scan

parathyroid glands inferior glands develop where?

thymus

Name the Pathology -located in the midline of the neck -creates a cystic mass above or below the hyod bone -found in peds, 90% of them before age 10

thyroglossal duct cyst

What is the most common congenital cystic anomaly?

thyroglossal duct cyst

The thyroid develops at the same location at the base of the ____.

tongue

Name the Pathology condition where nodular enlargement causes hyperactivity of the thyroid & hyperthyroidsm

toxic goiter

thyroid measurements age 1 > ____ l ____ AP ____ w adult > ____ l ____ AP ____ w isthmus > ____ AP

-25 mm, 12-15 mm, 10-15 mm -40-60 mm, 20-30mm, 15-20 mm -4-6 mm

Localized enlargement of the thyroid gland is called? Multiple thyroid nodules is called?

-Nodular Goiter -Multi Nodular Goiter

The thyroid is an endocrine gland that regulates metabolic function through the production of all of the following hormones except: a. thyroxine. b. triiodothyronine. c. thyrocalcitonin. d. thyroliberin.

ANS: D Thyroid hormones include thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin (calcitonin).

Common disorders associated with hyperthyroidism include all of the following except: a. toxic adenoma. b. toxic multinodular goiter. c. Grave's disease. d. acute thyroiditis.

ANS: D Toxic adenoma, toxic multinodular goiter, and Grave's disease account for 99% of patients with hyperthyroidism.

All of the following are sonographic findings of an abnormal lymph node except: a. Rounded shape b. Echogenic hilum c. Calcifications d. Enlargement

b. Echogenic hilum

All of the following are sonographic findings of malignant thyroid nodules except: a. Internal calcifications b. Echogenic mass c. Cervical node involvement d. Solitary mass

b. Echogenic mass

A 30-year-old patient presents to the sonography 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. Graves disease c. Hyperparathyroidism d. Cervical lymphadenopathy

b. Graves disease

Which abnormality is associated with the sonographic findings of a thyroid inferno? a. Hashimoto thyroiditis b. Graves disease c. Hyperparathyroidism d. Cervical lymphadenopathy

b. Graves disease

What is the most common cause of hypothyroidism? a. Graves disease b. Hashimoto thyroiditis c. Papillary carcinoma d. Parathyroid adenoma

b. Hashimoto thyroiditis

Name the Pathology -not associated with prior neck and chest radiation -spreads thru blood rather than lymphs -may not be differentiated with FNA (fine needle aspiration) -focal invasion of capsular -females affected 3x more -40-60 years -more aggressive than papillary

follicular carcinoma

How many parathyroid glands are there?

four

abnomal secretions of the thyroid have 2 forms what are they?

primary - dysfunction of thyroid gland secondary - dysfunction of the pituitary or hypothalamus

Name the Pathology -increased function of the parathyroid -abnormal secretion of PTH -caused by a parathyroid adenoma, hyperplasia, or parathyroid carcinoma

primary hyperparathyroidism

Hyperfunction of all parathyroid glands with no apparent cause occurs with which one of the following? a. Primary hyperplasia of the parathyroid glands b. Secondary hyperplasia of the thyroid gland c. Primary hyperparathyroidism d. Secondary hyperplasia of the parathyroid glands

ANS: A Primary hyperplasia is defined as hypofunction of primary hyperplasia of the parathyroid glands.

Increased vascularity with color Doppler, termed the thyroid inferno, is observed in ___________________. a. Hashimoto's disease b. Graves' disease c. de Quervain thyroiditis d. papillary carcinoma

ANS: B The overactivity of the thyroid gland in Graves' disease is manifested in the color Doppler image. This increase in vascular flow is termed the thyroid inferno.

All of the following structures form neighboring structures for the thyroid gland except the: a. longus colli muscle. b. parotid muscle. c. strap muscles. d. sternocleidomastoid muscle.

ANS: B The strap muscles lie anterior to the thyroid, and the sternocleidomastoid muscle lies anterior and lateral to the thyroid. The longus colli muscle is posterior and lateral to each thyroid gland.

A cystic formation located lateral to the thyroid gland in the neck is typically which one of the following? a. Thyroglossal duct cyst b. Branchial cleft cyst c. Cystic hygroma d. Sublingual cyst

ANS: B Typically, a branchial cleft cyst is located lateral to the thyroid. A cystic hygroma comes from the posterior occiput and is frequently observed in the lateral neck.

Usually _______ parathyroid glands exist. a. two b. three c. four d. five

ANS: C Generally, four parathyroid glands exist. Typically paired, they lie posterior to the superior and inferior poles of the thyroid gland.

Name the Pathology weight gain hair loss lethargy also called myxedema motor & intellectual slowing cold intolerence subcu tissue around eyes 75% of the time is caused by Hashimoto's

hypothyroidism

____ secretion of thyroid hormones may cause thyroid gland enlargement.

both insufficient and exccessive

Name the Pathology -cystic mass in the lateral portion of the neck -found laterally in the submandibular region -may have a diverticulum

branchial cleft cyst

The thyroid gland consists of ________ lobes. a. three b. four c. two d. six

ANS: C The thyroid gland consists of the right and left lobes connected across the midline by the thin bridge of thyroid tissue called the isthmus.