Thyroid gland study set!!!
Papillary carcinoma most commonly occurs between the ages of _____________, and is three times more common in _____________
20-50 women
What age range is most common with people who are diagnosed with papillary Carcinoma
20-50. Accounts for 75% to 85% of all thyroid cancers
Most adults have _____________ parathyroid glands: two _____________ located posterior to the mid-portion of the thyroid gland and two _____________ located in a more variable position
4 superior inferior
The mean length of the thyroid gland is _____________, mean AP diameter is _____________, and mean thickness of the isthmus is _____________
40 to 60mm 12 to 18mm 4 to 6mm
The thyroid gland___________. a)synthesizes thyroid hormone and parathyroid hormone b)stores iodine in parafollicular cells (c-cells) c)contains thyroid follicles, which contain colloid within their lumen d)a and c only
?
Which statement regarding this long axis view, taken along a parasagittal plane of the anterior neck, is correct? a)red color signal represents arterial flow b)blue color signal represents venous flow c)changing the PRF will vary red/blue signals d)all of the above
?
How many parathyroid glands do most adults have? A. 2 B. 4 C. 6 D. 8
B. 4
Which of the following is not a stap muscle? A. sternothyroid muscle B. sternohyoid muscle C. sternocleidomastoid muscle D. omohyoid muscle
C. sternocleidomastoid muscle
Which if the following transducers would be appropriate for evaluation of the thyroid gland and neck on an average patient? A. 7.5 MHz curvilinear B. 5 MHz phased array C. 5 MHz linear array D. 12 MHz linear array
D. 12 MHz linear array
Given three causes of hyperthyroidism. List five clinical symptoms of hyperthyroidism
Graves disease, toxic multinodular goiter, hyperfunctioning thyroid nodules, follicular thyroid carcinoma, thyroiditis, increased cardiac output, tachycardia, loud heart sounds, goiter, weight loss, nausea, vomiting, excessive sweating, flushing, heat intolerance, hair loss, restlessness
The most common cause or primary hypothyroidism is _____________ _____________
Hashimoto thyroiditis
What is the most common cause of primary hypothyroidism? List five clinical symptoms of hypothyroidism
Hashimoto thyroiditis cold intolerance, constipation, weight gain, dry skin, muscle aches, headaches
What interventions are recommended methods of improving thyroid gland imaging?
Have a patient swallow to bring the inferior pole of the thyroid into view.
What is classified as a strap muscle of the neck?
Thyrohyoid muscle
Calcitonin's overall effect is to decrease blood calcium levels, whereas parathyroid hormone's effect is to increase blood calcium levels.
True
The parathyroid glands vary in shape and number amongst the general population.
True
What best characterizes ultrasound imaging of the thyroid and parathyroid glands?
Ultrasound can be used to perform image-guided needle biopsies of thyroid masses. The thyroid gland is readily visualized with sonography in most patients.
Indolent
causing little pain (indolent tumor) or slow growing (indolent lesion or tumor)
Thyroglossal duct cyst
developmental fluid-filled spaces; congenital anomaly located anterior to trachea extending from the base of the tongue to the isthmus of the thyroid
Hyperparathyroidism
disorder associated with elevated serum calcium level, usually caused by a benign parathyroid adenoma
The thyroid is an _____________ gland that is made up of a _____________ and _____________ lobe, connected by a thin _____________ of tissue
endocrine right and left isthmus
Adenopathy
enlargement of the glands
Cervical Adenopathy
enlargement of the lymph nodes
Thyroid adenomas are benign nodules contained within a _____________ _____________. A minority of adenomas are toxic and cause _____________. Typically, an adenoma will demonstrate a _____________ _____________ surrounding the nodule. Sonographically, large adenomas have the characteristics of a _____________ _____________
fibrous capsule hyperthyroidism hypoechoic halo complex cyst
A definitive diagnosis of papillary carcinoma can be made by _____________ _____________ _____________. The overall survival rate of this type off thyroid cancer is _____________, making it the least aggressive form of thyroid cancer
fine needle aspiration 98%
Hurthle Cell Carcinoma
frequently grouped with follicular thyroid cancers as they have some similarities. The cells are also called oxyphilic cells and the cancer is referred to as oxyphil cell cancer. Hurthle cells are large thyroglobulin producing epithelial cells and are found in both nonneoplastic and neoplastic thyroid lesions
The echotexture of the normal thyroid gland is _____________, and _____________ when compared to the adjacent musculature
homogenous and hyperechoic
Parathyroid hormone
hormone produced by the parathyroid glands that regulate serum calcium and phosphorus
A condition that is associated with excessive release of thyroid hormones is called _____________, whereas one associated with a thyroid hormone deficiency is referred tp as _____________
hyperthyroidism hypothyroidism
Adenoma
Parathyroid adenoma is benign, solid tumor of the parathyroid gland that secreted parathyroid hormone, which results in elevated levels of serum calcium thyroid adenoma, a benign, solid tumor of the thyroid gland
What is the most common cause of hyperparathyroidism? List five clinical symptoms of hyperparathyroidism
hyperparathyroidism is caused by a parathyroid adenoma in 80% to 85% of cases and parathyroid hyperplasia in 10% to 15 % of cases. elevated serum calcium levels, weight loss, dyspepsia, peptic ulcer disease, renal colic, kidney stones, bone and joint pain, and gout
What correctly characterizes thyroid anatomy and physiology?
The thyroid consists of multiple follicles, each filled with colloid.
What characterizes thyroid gland anatomy?
The thyroid gland is composed of two lobes, generally connected by an isthmus. The thyroid gland is affixed to the cricoid cartilage and trachea.
What correctly categorizes thyroid gland and parathyroid gland sonography?
The thyroid gland should be imaged in sagittal, parasagittal, and transverse body planes. Normal adult parathyroid glands are not easily seen with sonography.
What correctly characterizes the sonographic anatomy of the anterior neck?
The vagus nerve is typically located between the medially positioned carotid artery and the laterally positioned internal jugular vein. The left recumbent laryngeal nerve is typically bordered by the left thyroid lobe, trachea, and esophagus.
Anaplasia
A loss of differentiation of cells that is a characteristic of tumor tissue and occurs in most malignant tumors
The Thyroid and Parathyroid both have what common function? A. endocrine glands B. exocrine glands C. sebaceous glands D. apocrine glands
A. endocrine glands
On sonographic examination, your patient presents with an enlarged heterogeneous thyroid gland. The patient's lab work is normal, and the patient is not experiencing any symptoms besides the palpable, enlarged gland. What is the most likely diagnosis? A. multinodular goiter B. graves disease C. hashimoto thyroiditis D. thyrotoxicosis
A. multinodular goiter
A patient presents for evaluation of the thyroid gland with a history of Hashimoto thyroiditis. Which of the following is not a common symptoms of this condition? A. weight loss B. cold intolerance C. menstrual irregularities D. fatigue
A. weight loss. Hashimoto thyroiditis is associated with hypothyroidism which results in weight gain
Which arrow is correct?
Arrow 1 identifies the superior pole of a thyroid lobe
What is identified by Arrow 2? Arrow 3? Arrow 1?
Arrow 2 - strap musculature Arrow 3 - Carotid Arrow 1 - isthmus
What correctly identifies the labeled structures in this transverse view ultrasound image of the anterior neck?
Arrow 3 identifies a thyroid lobe
Which type of thyroid cancer is seen in patients with a personal history of multiple endocrine neoplasia type 2 syndrome? A. papillary carcinoma B. medullary carcinoma C. follicular carcinoma D. anaplastic carcinoma
B. medullary carcinoma
What is the most common form of thyroid cancer? A. follicular B. papillary C. medullary D. anaplastic
B. papillary
While performing an examination of the thyroid gland, a small, solid, oval, homogeneously hypoechoic mass is seen posterior to the mid-lateral lobe of the thyroid gland. This appears to be separate from the thyroid gland. What is the most likely diagnosis? A. hyperplasia of the parathyroid glands B. parathyroid adenoma C. papillary carcinoma D. multinodular goiter
B. parathyroid adenoma
What is the main function of the thyroid gland? A. production of calcium B. storage of fats and vitamins C. regulation of the basal metabolic rate D. production of antibodies
C. Regulation of basal metabolic rate
Which of the following is not a typical symptom of Graves disease? A. hyperthyroidism B. elevated levels of T3 and T4 C. a shrunken echogenic thyroid gland D. bulging of the eyes
C. a shrunken echogenic thyroid gland
Fine-needle aspiration is not effective for diagnosing which form of thyroid carcinoma? A. papillary carcinoma B. medullary carcinoma C. follicular carcinoma D. anaplastic carcinoma
C. follicular carcinoma
Which of the following characteristics increases the suspicion for malignancy in a thyroid nodule? A. eggshell calcifications B. hyperechogenicity C. microcalcifications D. peripheral calcifications
C. microcalcifications
Which of the following is not a characteristic of a metastatic lymph node? A. increasing size on serial examinations B. microcalcifications C. prominent fatty hilum D. rounded, bulging shape
C. prominent fatty hilum
Which of the following regarding the anatomy of the neck and thyroid gland is false? A. the strap muscles are anterolateral to the thyroid gland B. the longus colli muscle is seen posterior to the thyroid gland C. the trachea forms the lateral border of the thyroid gland D. the common carotid artery and internal jugular vein are posterolateral to the thyroid gland
C. the trachea forms the lateral border of the thyroid gland
A radioiodine scintigraphy examination can be used to evaluate thyroid nodules. Which of the following statements regarding this examination is false? A. nodules may be classified as either hot or cold nodules B. a hot nodule traps an excessive amount of isotope and is hyperfunctioning c. a cold nodule does not absorb the isotope and demonstrates an area of deceased or absent activity D. all cold nodules are malignant
D. all cold nodules are malignant
Which aggressive form of thyroid cancer has a tendency to compress and destroy the local structures of the neck? A. papillary carcinoma B. medullary carcinoma C. follicular carcinoma D. anaplastic carcinoma
D. anaplastic carcinoma
What is the most common functional disorder of the thyroid gland? A. hyperthyroidism B. thyrotoxicosis C. Graves disease D. hypothyroidism
D. hypothyroidism
What is the most common cause of primary hyperparathyroidism? A. breast of prostate cancer B. chronic renal insufficiency C. parathyroid carcinoma D. parathyroid adenoma
D. parathyroid adenoma
Which of the following is not a characteristic of benign thyroid nodules? A. a uniform hypoechoic halo B. avascularity C. well-defined, regular margins D. taller-than-wide shape
D. taller-than-wide shape
What are well-described anatomic variants of the thyroid gland?
Ectopic thyroid tissue (linguinal) Absence of thyroid isthmus A pyramidal lobe
Endemic disease of thyroid
Endemic goiter is an adaptive disease produced by the persistent stimulation of the thyroid gland as consequence of the thyrotropin increased secretion due to the iodine deficiency
Goiter
Focal or diffuse thyroid gland enlargement due to iodine deficiency; multiple nodules may be present
What is the second most common thyroid cancer?
Follicular carcinoma. Accounts for 10% to 20% of diagnosed cases. There is an increased incidence in geographic areas of endemic goiter where there is dietary iodine deficiency, whereas papillary carcinomas are more common in areas of sufficient or excess iodine intake.
Thyroid Stimulating Hormone (TSH)
Hormone secreted by the anterior pituitary gland that stimulates the thyroid gland to secrete thyroxine (T4) and triiodothyronine (T3)
What is true regarding thyroxine?
It contains four iodine ions. It is converted to T3 in peripheral body tissues.
Calcitonin affects the blood's serum calcium levels by acting at which sites?
Kidneys Bones Intestines
What correctly characterizes thyroid hormone regulatory control?
The hypothalamus releases TRH. TRH stimulates the release of TSH. Decrease in TRH and TSH results in a decrease in thyroid hormone production. Both the anterior pituitary gland and hypothalamus play prominent regulatory roles.
What characterizes the sonographic appearance of the thyroid gland and surrounding structures?
The longus colli muscle runs posterior to the thyroid lobes
Graves disease
an autoimmune hyperthyroidism caused by antibodies that continuously activate thyroid-stimulating hormone receptors; it is characterized by enlarged thyroid, protrusion of eyeballs (exophthalmos), a rapid heartbeat, nervous excitability
What is cystic hygroma?
a cystic hygroma is a congenital modification in the cervical lymphatic system. over 60% are associated with chromosomal abnormality such as Turner syndrome but other aneuploidies are common such as trisomy 21 and trisomy 18 these benign congenital masses occur at many sites but most often appear from the posterior occipital region and are most frequently visualized sonographically as large cystic masses on the lateral aspect of the neck. usually appears thin-walled and can be multilocular and multiseptated
Medullary Carcinoma
accounts for no more than 5% of all thyroid carcinoma. It is a neuroendocrine neoplasm derived from the thyroid gland's parafollicular cells, which are similar to normal cells but secrete calcitonin (C cells). Serum calcitonin can be used as a tumor marker
Primary hyperplasia is enlargement of _____________ _____________ _____________ and should be expected when _____________ nodules are identifies, whereas _____________ _____________ should be suspected when a solitary nodule is identified
all four glands multiple parathyroid adenoma
Malignant thyroid nodules are typically solid and _____________ when compared to the normal thyroid parenchyma. The presence of _____________ is one of the most specific sonographic features of thyroid malignancy. They are commonly found in _____________ thyroid cancer
hypoechoic microcalcifications papillary
Maintenance of the concentrations of T3 and T4 is controlled by a regulatory system that involves the _____________, the _____________, and the thyroid gland
hypothalamus and pituitary gland
Thyroid inferno
increase in color doppler vascular flow in the thyroid
Thyroiditis
inflammation of the thyroid
Thyroid veins drain into the _______
internal jugular veins and brachiocephalic veins
Fine-needle aspiration (FNA)
invasive procedure using a small gauge needle to obtain a tissue specimen from a specific lesion
Sternocleidomastoid muscles
large muscles located anterolateral to the thyroid
Hypophosphatasia
low phosphatase level that can be seen with hyperparathyroidism
Hashimoto thyroiditis (chronic lymphocytic thyroiditis or hashimoto disease)
most common inflammatory disease of the thyroid gland; usually occurs in genetically predisposed individuals, often presents in patients with other autoimmune disorders that may be associated with the formation of antibodies against normal thyroid tissue, and often accompanies by marked hyperemia
A nontoxic goiter refers to an enlargement of the entire gland without evidence of discrete _____________ and without _____________ disturbance. Simple goiters may convert into _____________ goiters, demonstrated by a multilobulated, asymmetrically enlarged gland
nodularity functional multinodular
Heterotopic
occurring at an abnormal place or upon the wrong part of the body
Primary hyperparathyroidism
oversecretion of parathyroid hormones
Hyperthyroidism
oversecretion of thyroid hormones
The parathyroid glands are responsible for producing _____________ _____________, which regulates the concentrations of _____________ and _____________
parathyroid hormone calcium and phosphorus
The common carotid artery and internal jugular vein form the _____________ _____________ border of the thyroid gland. The _____________ _____________ muscle is seen posterior to the gland
posterior lateral longus colli
Cold Nodule (photon-deficient area)
seen on a nuclear medicine study as region of thyroid were the radioisotope has not been taken up; the area may correspond to a palpable mass
Describe the technique used to perform a fine-needle aspiration of a suspicious thyroid nodule
sterile technique is used as a 25-guage needle is guided into the thyroid nodule using sonography. Two techniques can be used: a syringe can be used to create mild suction or the capillary action of the needle alone can be used. The needle is repeatedly moved back and fourth within the nodule to collect cells and tissue, which are then submitted for cytological evaluation
Strap muscles
sternohyoid and sternothyroid muscles located anterior to the thyroid
The _____________ and _____________ thyroid veins drain into the IJV, whereas the _____________ thyroid veins drain into the brachiocephalic veins
superior and middle inferior
The thyroid gland receives a rich blood supply from four arteries: the paired _____________ _____________ _____________, which arise from the external carotids, and the _____________ _____________ _____________, which originate at the thyrocervical trunk of the subclavian artery
superior thyroid arteries inferior thyroid arteries
Papillary carcinoma
the most common form of thyroid cancer
You are asked to evaluate the parathyroid glands during a sonographic examination of the neck. What landmarks will you use to locate the parathyroid glands?
the parathyroid glands are typically located between the posteromedial thyroid gland and the longus colli muscle. The superior parathyroid glands are slightly more medial to the carotid artery, posterior to the lateral lobe, and anterior to the longus colli muscle
Euthyroid
the thyroid gland is producing the right amount of thyroid hormone
Isthmus
thin band of thyroid tissue connecting the right and left lobes
Congenital cysts of the neck include _____________ _____________ _____________, which tend to be midline, and _____________ _____________ _____________, which tend to lie lateral to the carotid artery
thyroglossal duct cysts brachial cleft cysts
_____________ is a hypermetabolic state caused by elevated levels of free _____________ and _____________. The majority of patients with hyperthyroidism have _____________ disease, which is an _____________ disease
thyrotoxicosis (hyperthyroidism) T3 and T4 graves disease autoimmune disease
Microcalcifications
tiny hyperechoic foci that may or may not shadow; sometimes present within a thyroid nodule
The thyroid gland secretes three hormones: _____________, _____________, and _____________. _____________ is needed to properly synthesize the hormones
triiodothyronine (T3), Thyroxine (T4), and calcitonin iodine
Hypothyroidism
underactive thyroid hormones
Anaplastic Carcinoma
undifferentiated tumors of the thyroid follicular epithelium. accounts for less that 5% of thyroid malignancies
Longus colli muscles
wedge-shaped muscle posterior to the thyroid lobes