Thyroid Ultrasound 1

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59 Terms

1
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What is the size of the thyroid?

4-6 cm

2-3 cm in depth and width

2
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What is the size of the isthmus?

2-6mm

3
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The structure connecting the right and left lobes of the thyroid is?

The isthmus

4
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Euthyroid function means the thyroid function is?

Normal

5
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What are the muscles anterior to the thyroid?

Strap muscles

-Sternohyoid

-Sternothyroid

-Omohyoid

6
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Which muscle is located posterior to the thyroid?

Longus colli muscle

7
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What is the function of the thyroid?

Produces, Stores and Secretes hormones

Regulates body growth

Body development

Controls metabolism

8
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Increased levels of TSH indicate what?

Hypothyroidism

9
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Decreaded levels of TSH indicate what?

Hyperthyroidism

10
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Another name for TSH is?

Thyrotropin

11
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Increased T3 and T4 indicate

Decreased T3 and T4 indicate

Hyperthyroidism

Hypothyroidism

12
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What are some symptoms of hypothyroidism

Weight gain

Hair loss

Lethargy

Enlarged goiter

Cold

13
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T/F Hashimoto's is a form of Hyperthyroidism

False, Hypothyroidism

14
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Symptoms of Hyperthyroidism

Weight loss

Increased Appetite

Nervousness

Sweating

Enlarged goiter

15
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T/F Hot nodules on NM exam are worrisome for thyroid cancer

False Cold nodules 20% malignant don't take up iodine

Hot nodules are non-malignant

16
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What are some reasons for performing a thyroid ultrasound

Abnormal TFT's

Palpable nodule

Enlarged thyroid

Difficulty swallowing/ breathing

Evaluation of a cold nodule on NM exam

Follow-up

Assist in biopsy/ FNA of nodule

17
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Describe the proper patient position for performing a thyroid ultrasound

Supine

Pillow under shoulders

Hyperextend neck

18
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What are some questions you would ask your patient before performing an ultrasound?

Palpable mass

Thyroid medications

Abnormal labs

Previous imaging

Family hx of thyroid CA

Hx of radiation or prior thyroid surgeries

19
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Thyroid protocal

Bilateral TRV w and w/o color

Isthmus

Rt/Lt Lobe Sag w and w/o color

Rt/Lt Lobe Sag Med

Rt/Lt Lobe Sag Lat

Rt/Lt Lobe Trv Sup

Rt/Lt Lobe Trv Mid w and w/o color

Rt/Lt Lobe Trv Inf

Scan Lat to great vessels for abnormal lymph nodes

Document and measure any masses

20
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Why would you scan lateral to the jugular veins when performing a thyroid ultrasound?

To look for enlarged or abnormal lymph nodes

21
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Normal thyroid sonographic appearance

Homogenous texture

Medium level echogenicity

Echogenic Capsule

22
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Normal lymph node appearance

Hypoechoic

Oval

Echogenic Hilum

Vascular hilum

< 0.5

23
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Overall worldwide, the most common cause of thyroid disorders is?

iodine deficiency

24
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Most common cause of thyroid disorders in developed countries is?

autoimmune processes

25
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What is the definition of a thyroid goiter?

Enlargement of the thyroid gland

26
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Causes of a goiter?

Compensatory hypertrophy and hyperplasia

Graves' Disease

Throiditis

Neoplasm

Cyst

27
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Nontoxic goiter

Diffuse Thyroid enlargement

Can be result of iodine deficiency

Normal or hypothyroid secretion

Within the control of pituitary gland

28
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Toxic goiter

Most common forms of thyroid disease

Results in an enlarged nodular gland

Hypersecretory

Often caused by excessive stimulation from TSH

29
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Graves disease

Women

>30 years old

Autoimmune disorder

Thyrotoxicosis

Most common cause of Hyperthyroidism

"thyroid inferno"

30
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What is the classic clinical finding seen in patients with graves disease?

Exophthalmos

31
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Thyroiditis can be caused by?

Caused by infection

Can be autoimmune

Causes swelling and tenderness

Destroys thyroid gland

32
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What are the two types of thyroiditis

De Quervain's Thyroiditis

Hashimotos

33
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What is De Quervain's

Viral infection

Diffuse enlargement and inflammation

Eventually gland returns to normal

34
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Hashimoto's Disease

Autoimmune disorder

Causes chronic inflammation

Usually occurs in young-mid aged women

Thyroid is diffusely enlarged

Hypothyroidism

Increased rate of malignancy

35
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Describe the typical sonographic appearance of Hashimoto's disease

Heterogenous

Hypervascular

Coarse texture

Fibrotic septations

Enlarged

36
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How can you tell the difference between a thyroid affected by graves disease vs. hashimoto's disease?

Through labs

Sonographically there is no differance

37
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What are two benign thyroid lesions

Thyroid cysts

Adenoma

38
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Adenoma

Benign

Females 7x more than Males

Euthyroid-normal

Hyperthyroid

Can be multiple

39
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Sonographic findings of an adenoma

Variable

From anechoic to Hyperechoic

Fibrous capsule

Well circumscribed

May have a hypoechoic halo

May have a calcified rim

Can have hemorrhage

Necrosis

40
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What are some risk factors for malignant thyroid lesions

Age 25-65

Female

Asian

Family history

History of radiation to head or neck

41
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What are the types of malignant thyroid lesions

Papillary Carcinoma

Follicular Carcinoma

Medullary Carcinoma

Anaplastic Carcinoma

Lymphoma

42
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Papillary Carcinoma 5

1.Most common

2.Least aggressive

3.Good prognosis

4.25% Mets to cervical lymph

5.Small punctate calcifications

43
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Follicular Carcinoma 4

1. Single mass

2. 2nd most common

3. Spreads through blood

4. Mets to 4 thing

-Brain

-Lung

-Bone

-Liver

44
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Medullary Carcinoma 3

1. 10%

2. Nodule or whole gland

3. Microcals

45
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Anaplastic Carcinoma

Rare

Rapid growth

Highly metastatic

Elderly patients

Invade through surrounding muscles

46
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Lymphoma

Non-Hodgkin's type

Primarily affects older women

Rapidly Growing

Chronic Hashimoto's

47
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Abnormal Cervical lymph nodes

Rounded

Hypoechoic

Absence of fatty hilum

Punctate Calcs

Cystic changes

>0.5

48
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Cysts of the neck

Brachial cleft cysts

-Congenital

-Lat neck mass

-Beneath mandible

Cystic Hygroma

-inadequate drainage of lymph fluid

-Post neck mass

Thyroglossal Cyst

-Embryonic remnant

-Anterior

-between tongue and isthmus

49
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What are some Pitfalls Of Thyroid Imaging

Edge refraction shadowing from muscles anterior

Clavicle

Swallowing/ Breathing/Talking

Taut neck muscles

50
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Parathyroid glands

4 total

< 4mm

> 5mm is considered abnormal

51
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What is the function of the parathyroid

Regulates blood calcium levels

-bone

-intestines

-kidneys

52
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Decreased calcium levels causes Parathyroid gland to produce and secrete what?

more PTH

- Causes glands to enlarge

- Pregnancy can also cause glands to enlarge due to an increased need for Calcium

53
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Increased calcium levels causes Parathyroid glands to?

stop producing PTH

54
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Primary hyperparathyroidism

Increased function

Woman are affected 2-3x more than men

Common after menopause

Leads to Hypercalcemia and Hypercalciuria

Asymptomatic

55
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The most likely cause of hyperparathyroidism is?

Adenoma

56
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Parathyroid Adenoma

Benign

< 3cm

1 gland

Hypoechoic

Symptoms: "Stones, Bone, Groans and psychic overtones"

57
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Secondary Hyperparathyroidism

Hypocalcemia

Caused by

-Renal failure

-vitamin D deficiency

-malabsoption

Causes stimulate parathyroid to excrete excessive PTH

Affects all 4 glands

58
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Hypoparathyroidism

Undersecretion of PTH

Rare

Can be

-Congenital

-Genetic

-Autoimmune

-Caused by removal of parathyroid glands

Treated with Vitamin D and Calcium

59
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Parathyroid cancer

Very Rare

Small

Difficult to diagnose early