Tuesday, September 17, 2013

9/17/2013

9/16/2013

Answers:
Thyroid stimulating immunoglobulin (TSI) is positive in 90% of patients with...
A) Hashimotos
B) de Quervains
C) Graves'
D) Hypothyroidism
E) None of the above


Thyroid stimulating immunoglobulin (TSI) is + in 90% of Graves’ pts but negative in normals and hashimotos.

Describe the three maneuvers used when examining the thyroid gland.

The pt should slightly flex their neck (in order to relax the SCM), one should observe the thyroid while the pt swallows (often a sip of water), and one should palpate the thyroid from behind by placing the three middle fingers on the gland while the pt swallows.

MC Questions:

What percentage of FNAs demonstrate a benign lesion?
A) 10% 
B)25% 
C)50% 
D) 75% 
E) 90%

Free Response Question:
If a thyroid nodule is evaluated with a 99mTc pertechnetate scan and found to be "hot", what significance does this have?


Quick Facts:

Management of thyroid nodules
-Malignant = total thyroid w or w/o neck dissection.
-Follicular often indeterminate due to difficulty telling follicular carcinomas from follicular adenomas on FNA.    
-Need vascular/capsular invasion to diagnose follicular carcinoma.
-If benign, follow up clinically w/ serial US.-L
-Thyroxine not recommended.
-If increasing in size, reexamine w/ FNA.
-Eval is same in pregnancy but no radionucleotide scans are done.  If differentiated cancer found can delay surgery until post delivery.

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