Thyroid and Parathyroid

Need to be very careful with thyroid surgery because that area is very vascular and any excessive bleeding could lead to serious complications, such as damage to surrounding structures or prolonged recovery time.

Parathyroid gland is very small and can be mistaken for a lymph node

• Most common cause of hypoparathyroidism is iatrogenic

Complete and severe injury to recurrent laryngeal nerve can result in voice changes or vocal cord paralysis, leading to airway collapse

• If there is vocal cord paralysis post-extubation, tracheostomy needs to be done

Most of the time, the patients presenting are relatively young in age (25-35 y/o)

Fine needle aspiration biopsy may excise benign cells of a malignant nature, allowing for accurate diagnosis and management of thyroid nodules or tumors. In cases of suspicious nodules, further imaging and evaluation should be conducted to determine the appropriate surgical or medical interventions.

Family history, lymph node assessment are extremely important for thyroid and breast cancer

To identify thyroglossal duct cyst, have them stick out their tongue; this action will reveal any midline swelling, which could indicate the presence of the cyst.

Hoarseness is very important for thyroid nodules because it can infiltrate into the recurrent laryngeal nerve

• Even if a nodule is confirmed benign, if there are red flag signs like positive family history or hoarseness, it is best to do hemithyroidectomy

First imaging is always ultrasound

• If ultrasound shows evidence of suspicion, FNA

FNA cannot diagnose follicular lesions definitively, as it does not provide information on the capsular or vascular invasion that can indicate malignancy.

Anaplastic thyroid cancer is the worst cancer; they will need removal of gland and isthmus and has a very poor prognosis

• Once it shows physically (palpable mass), it’s already too late

• Gland and isthmus removal is rare because of the very fast progression

Molecular testing: RAS and BRAF

• BRAF is associated with worse cancers

• Generally not done because very expensive

Most of the time, the nodules aren’t clinically significant, but you still see those patients because the nodules are incidental findings on imaging studies. It's essential to monitor these patients to ensure there are no changes in the size or characteristics of the nodules.

Higher risk nodules will grow 2+ mm per year

Thyroid storm is a very serious endocrine emergency; it results from an excess of thyroid hormones and can lead to severe consequences if not treated promptly. Symptoms include high fever, tachycardia, agitation, and altered mental status, requiring immediate medical intervention.

• Amiodarone is a prime suspect for kicking off thyroid storm, especially if history of arrhythmia

• The most definitive treatment is thyroidectomy; it will not respond to medications, but you should still give it to buy time to get them into OR

Hypocalcemia will lead to respiratory failure

With tertiary hyperparathyroidism, the parathyroid glands become hyperplastic due to prolonged renal failure, resulting in elevated calcium levels and associated complications.

• That’s to say even with a kidney transplant, parathyroid gland is still gonna go haywire

Will need to send them to surgery if very overtly symptomatic, calcium is more than 11, or if there are signs of acute complications such as cardiac arrhythmias or severe bone pain.