Thyroid Powerpoint First 1/2

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First

24th

Thyroid sac

Embryololgy:

  • The thyroid gland is the ____ of the endocrine glands to develop.
  • It develops on approximately the ____ day of gestation.
  • The thyroid gland arises from a median, saclike diverticulum (called the ___ ____).
2

Thyroglossal; 6th

Thyroglossal

Pyramidal

Embryology:

  • The _____ duct atrophies by the ___ week of embryonic development.
  • The ______ duct normally closes after birth.
  • If it fails to close, then cysts, fistulas, or an accessory _____ lobe may develop.
3

Endocrine

Metabolism, growth, development

Triiodothyronine (T3); thyroxine (T4); calcitonin

  • The thyroid gland is part of the _____ system.
  • It helps maintain body _____, ____, and ______.
  • This is accomplished through the synthesis, storage, and secretion of thyroid hormones.
4

Triiodothyronine (T3); thyroxine (T4); calcitonin

Enlarged

Superficial; high

  • These hormones include ______ (__), ______ (___) and ______.
  • The thyroid is generally only palpated on physical exam if it is _____ (either focally with a nodule or diffusely).
  • The thyroid gland is a ______ structure, so _____ resolution ultrasound should be used to examine it.
5

Anatomic structure

Biopsies; aspirations

Functional

  • Ultrasound is used to evaluate the ______ ______ of the thyroid and the anatomy surrounding it.
  • Ultrasound can also be used to guide physicians during invasive procedure, such as _____ or ______ of the thyroid gland.
  • Lab measurements and nuclear scintography is used to evaluate the ______ state of the gland.
6

Anterior

Rt; Lt; isthmus

Pyramidal

Isthmus

  • The thyroid gland is located in the lower, ____ neck.
  • It consists of a ____ and ____ lobe, which are connected across the midline by a thin bridge of thyroid tissue called the ____.
  • A _____ lobe, which extends superiorly from the isthmus, is present in 15% to 30% of thyroids
  • The ____ is directly anterior to the trachea, and the right and left lobes of the thyroid gland extend on either side of the trachea
7

Sternocleidomastoid; strap; anterolateral

Jugular; carotid

  • The _______ and ____ muscles are situated _____ to the thyroid gland.
  • The ____ veins and the ____ arteries can be seen lateral to the thyroid gland on both sides of the neck.
8

Pyramidal

Superiorly

  • The _____ lobe is a third lobe that is present in a small percentage of patients.
  • It extends _____ from the isthmus.
9

Gender; age; body surface area

Right

Women; men

Size:

The size and shape of the thyroid gland vary greatly with ____, ____, and _____.

The ____ lobe is often the larger of the two lobes.

_____ tend to have larger thyroid glands then ____.

10

Oval; elongated

4-6; 2-3; 1.5-2

  • In shorter patients, the gland tends to be more ____ shaped, and in taller patients, the gland is more ____.
  • The size range of the normal adult thyroid gland __-__cm in length __-__cm in AP diameter __-__cm in width
11

Four

Superior; external carotids

Inferior; thyrocervical trunk; subclavian artery; lower

Jugular

  • The thyroid gland is supplied with blood by ___ arteries.
  • There are two ____ thyroid arteries that arise from the ____ ____ and descend to the upper poles.
  • There are also two ____ thyroid arteries that come from the _____ ____ of the _____ _____ and ascend to the ____ poles.
  • Corresponding veins drain into the internal ____ veins.
12

Iodine metabolism

Blood; triiodothyronine; thyroxine

  • The method for producing thyroid hormones is _____ _____.
  • The thyroid gland traps iodine from the ___ and, through a series of chemical reactions, it produces the thyroid hormones _____ and _____.
13

Colloid

Thyrotrophic; thyroid-stimulating hormone (TSH)

Pituitary

Thyrotrophic; hypothalamus

  • The hormones are stored in the _____ of the gland.
  • When the body needs these hormones, they are released into the body by the action of _____, which is also known as ______.
  • TSH is produced by the ____ gland.
  • The secretion of TSH is regulated by _____ releasing factor which is produced by the _____.
14

Calcitonin

Calcium

Blood calcium

Calcium

  • The thyroid gland also secretes _____.
  • Calcitonin decreases the concentration of ____ in the blood -acting on bone to inhibit its breakdown.
  • Calcitonin secretion increases after any increase in the ____ ____ concentration.
  • It helps to prevent an excess of _____ in the blood (hypercalcemia) from occurring.
15

Euthyroid

Hypothyroidism

Hyperthyroidism

Function

_____ - the state in which the thyroid is producing the right amount of thyroid hormone.

_____ - undersecretion of thyroid hormones

_____ - oversecretion of thyroid hormones

Usually a blood test is used to assess thyroid ____

16

Patient history

Hyperparathyroidism; thyroid cancer

Radiation

  • Sonographers needs to take a thorough ____ _____ before beginning the exam.
  • thyroid medications
  • previous imaging studies
  • family history -______ or ____
  • prior history of ____ or surgery to the neck.
17

Supine

Hyperextension

Opposite

High

  • patient should be in the ____ position on the table.
  • A pillow can be placed under the patient’s shoulders to cause ______ of the neck, thus providing better access to the patient’s neck and allowing for optimal sonographic images.
  • The patient’s neck may also be turned in the ____ direction of the side being examined.
  • A ____ resolution (7.5-12MHz) linear transducer should be used.
18

Sagittal; transverse

Lateral; mid; medial

Superior; mid; inferior

Isthmus

  • You must scan through each lobe in ____ and _____.
  • In sagittal - the ___, ___ and ____ parts of the lobe should be examined and labeled accordingly.
  • In the transverse plane - the ___, ___, and ____ portions of the gland should be examined and again labeled accordingly.
  • The ___ must also be examined and imaged
19

Homogeneous; echogenic

Carotid; jugular

Left; hypoechoic; echogenic

  • Normal thyroid tissue is ____ and is _____ compared to the surrounding muscle structures.
  • The ___ artery and the ____ vein can be seen lateral to the gland.
  • The esophagus may be seen to the ___ of the midline, next to the trachea, with a ____ rim surrounding an ____ center.
  • If an abnormality is encountered: multiple images should be taken to demonstrate the sonographic characteristics (cystic areas, calcifications, enhancement, etc).
20

Correct

Hypothyroidism; hyperthyroidism

  • If the thyroid is producing the ____ amount of thyroid hormones it is said to be normal or euthyroid.
  • Abnormal secretions of the thyroid hormones can lead to ____ or _____.
21

Hypothyroidism

Iodine

_____ occurs when there is an under secretion of thyroid hormones.

This condition can be caused by low intake of ____, inability of the thyroid to produce the proper amount of thyroid hormone or a pituitary gland issue.

22

Gain

Increased

Hypothyroidism: Signs and Symptoms

myxedema (dry skin and swellings around lips and nose as well as mental deterioration)

weight ___

hair loss

____ subcutaneous tissue around the eyes

Lethargy

23

Cold

Husky voice

Thyroid hormones

Hypothyroidism: Signs and Symptoms

intellectual and motor slowing

___ intolerance

constipation

deep ___ ___

Treatment: ____ ____ can reverse the condition.

24

Over

Overproduction

Increases

Hyperthyroidism:

___ secretion of thyroid hormones

This usually occurs when the entire gland is out of control or if a localized neoplasm causes ____ of the thyroid hormone.

Hyperthyroidism greatly ____ the metabolic rate.

25

Loss

Increased

High

Hyperthyroidism: Signs and Symptoms

weight ___

____ appetite

___ degree of nervous energy

Tremor

26

Heat

Protruding eyes

Hyperthyroidism: Signs and Symptoms

excessive sweating

___ intolerance

palpitations

many patients show signs of exopthalmos (____ _____).

27

Thyroid hormones; radioactive iodine; surgical removal

Hyperthyroidism: Treatment

Can also be treated with _____ _____ as well as _____ ____ treatment or ____ ______ of the gland or of a mass if present.

28

Nuclear; function

Radioactive iodine

24

Measuring Thyroid Function with Nuclear Medicine:

  • _____ medicine is used to determine the ____ of the thyroid.
  • This is performed by injecting a small amount of ____ ____ into the bloodstream.
  • In normal individuals, a certain percent of the amount injected will be taken into the thyroid gland within ___ hours.
29

Greater

Smaller

Measuring Thyroid Function with Nuclear Medicine:

  • In patients with hyperthyroidism, a _____ percent is taken up.
  • In patients with hypothyroidism, a _____ percent is taken up.
  • The amount taken up by the thyroid gland is determined by measuring the radioactivity accumulated in the gland with a gamma camera.
30

Benignity; malignancy

Hot; benign

Cold; malignant

Hot vs. Cold Nodules:

  • Nuclear medicine scans are often used to assess the likelihood of _____ or ____ of a nodule.
  • A “___” nodule is a nodule that takes up iodine. This nodule is considered to be likely to be ____.
  • A “___” nodule is a nodule that does not have high levels of iodine uptake. This may suggest that the nodule is _____.
31

T3; T4

Hyperthyroidism

Decreased

Lab Tests to Measure Thyroid Function:

  • Blood can be taken from a patient and the amount of the thyroid hormones ___ and ___ can be measured.
  • T3 and T4 will be elevated in patients with _____
  • The thyroid hormone levels will be _____ in patients with hypothyroidism.
32

Hyperplasia (Grave's Disease)

Goiter

Adenoma

Disorders Associated with Hyperthyroidism

Common:

  • -Diffuse toxic _____ (____ _____)
  • -Toxic multinodular ____
  • -Toxic ____
33

Thyroiditis

Hyperfunctioning

Hydatidiform mole

TSH

Thyrotoxicosis

Disorders Associated with Hyperthyroidism

Uncommon:

  • -Acute or subacute ____
  • -_____ thyroid cancer
  • -Choriocarcinoma or _____ ____
  • -___ secreting pituitary adenoma
  • -Neonatal ______ associated with maternal Grave’s disease
34

Iodine; goiter; hypothyroidism

Autoimmune

Goiter

  • The most common cause of thyroid disorders worldwide is ____ deficiency, leading to ____ formation and _____.
  • In areas not deficient in iodine, _____ processes are believed to be the basis for most cases of thyroid disease, which ranges from hyperthyroidism or hypothyroidism.
  • Enlargement of the gland is termed ____.
35

Enlargement

Hyperplasia; follicular epithelium

Esophagus

Goiters

Nodular Thyroid Disease:

  • goiter is an _____ of the thyroid gland.
  • This is often due to ____ of the ____ ____ caused by a derangement that hampers hormone secretion.
  • A goiter may become very large, compressing the _____ and interfering with swallowing
  • Other causes of ____ are Graves’ Disease, thyroiditis, neoplasm or a cyst.
36

Large

Low

T3; T4

Edemic Goiter:

  • Effects ____ groups of people in a specific geographic area.
  • Usually occurs in areas where there are ___ iodine levels in the soil and food (ex: mountainous areas or around the Great Lakes)
  • Normally, the iodine is trapped by the thyroid gland and used to synthesize ___ and ___ hormones.
37

Dietary deficiency

Hyperplasia; hypertrophy

Iodized salt

Edemic Goiter:

  • This _____ _____ leads to low T3 and T4 production and a compensatory increase in thyroid stimulating hormone (TSH) from the pituitary gland.
  • This causes _____ and _____ in the gland.
  • For the most part, ____ ___ has solved this problem.
38

Hyperthyroid; hyperactivity

TSH; nodular

Toxic Goiter:

  • A ____ condition resulting from _____ of the thyroid gland.
  • This may be caused by excessive stimulation from ___ and results in a ___ nodular gland.
39

Most common

Diffuse and symmetric; irregular and nodular

Hyperplasia, neoplasm, inflammatory

Enlargement

  • Nodular hyperplasia, multinodular goiter, and adenomatous hyperplasia are all terms used to describe goiters. This is the ____ ____ thyroid abnormality.
  • Goiters can be ____ and ____ or ____ and _____.
  • Goiters may result from ____, _____, or an _____ process.
  • _____ of the gland can be caused by normal thyroid function, hyperfunction, or hypofunction.
40

Heterogeneous

Location; characteristics

Sonographic Findings of Thyroid Goiters:

  • Usually demonstrates that the goitrous gland is enlarged, nodular, an sometimes _____.
  • Sonography is helpful in the evaluation of nodular thyroid disease. It can help to determine the ____ and ______ of palpable neck masses.
41

Enlargement; neoplasm; inflammation

Not

Nontoxic (simple) goiters:

  • Occur as a diffuse thyroid _____ not resulting from a ____ or ____.
  • It is ___ usually associated with hypothyroidism or hyperthyroidism.
42

Unable; thyroid

Shortage; malfunction

Diffusely; uniformly enlarges

Nontoxic (simple) goiters:

  • The goiter is formed when the gland is ____ to provide an adequate supply of ____ hormone.
  • This deficiency may be the result of iodine ____ or ____ of the gland itself.
  • The gland becomes _____ and ____ ____ in an attempt to trap and use every atom of iodine.
43

Able

Lags; hypothyroidism

Nontoxic (simple) goiters:

  • Often the gland is ___ to keep up with normal release of hormones.
  • However in some cases, the gland ____ behind the demand and the patient develops _____.
44

Hyperplasia; colloid

Asymmetric; nodular; hemorrhage; calcification

Nontoxic (simple) goiters:

  • In the first stage of nontoxic goiters, _____ occurs and in the second stage, _____ involution occurs.
  • Progression of this process leads to an ______ and _____ gland with ____ and _____.
45

Enlargement; smooth; nodular

One side

Compression

Sonographic Findings of Simple (Nontoxic) Goiters:

  • Findings include _____ of the gland. They are sometimes _____ and sometimes _____.
  • ____ ____ may enlarge more than the other.
  • _____ of the surrounding structures may be noted on ultrasound.
46

Most common

80%; hyperplasia

Spontaneously; nontoxic

Toxic Multinodular Goiter (Adenomatous Hyperplasia):

  • One of the ____ ____ forms of thyroid disease.
  • Approximately ___% of nodular thyroid disease is caused by _____ of the gland.
  • Although some cases of multinodular goiter arise _____, most are believed to begin as ____ goiters that have overtaken the gland.
47

Enlarged; inhomogeneous

Focal scarring; ishemia; necrosis, cyst

Sonographic Findings of Toxic Multinodular Goiter:

On ultrasound, the gland will be _____ and ______.

As the disease progresses, areas of ____ ____ and ____, as well as ____ and ____ formation, may appear within the gland.

48

Fibrosis; calcifications

Encapsulated; circumscribed

More

Sonographic Findings of Toxic Multinodular Goiter:

  • ____ and _____ may form.
  • Some nodules will appear _____ and some will be poorly _____.
  • One side of the gland may have ____ nodules than the other.
49

Adenomas

Adenomatous hyperplasia; halos

Same

Calcifications; cystic

Sonographic Findings of Toxic Multinodular Goiter:

  • Lesions in a multinodular goiter have many sonographic features of true _____.
  • The multiple nodules of ______ _____ may demonstrate ____ and may have clear or non-discrete borders.
  • The solid portion of the lesions may have the ____ echo texture as the normal thyroid tissue.
  • Again, _____ and ____ areas may be seen.
50

Women; 30

Autoimmune

Thyrotoxicosis; hyperthyroidism

Grave's Disease:

  • Occurs most frequently in _____ over ___ years old.
  • Related to an _____ disorder.
  • It is characterized by _____ and is the most frequent cause of ______.
51

Toxic

Exophthalmos

Cutaneous manifestations

Grave's Disease:

Characterized by the following findings:

  • Hypermetabolism
  • diffuse ____ goiter
  • ______ (inflammatory infiltration of the orbital tissues resulting bulging of the eyes)
  • _____ _____ (thickening of the skin)
52

Hypoechoic; homogeneous

Enlarged

Increased; color; thyroid inferno

Sonographic Findings of Grave's Disease:

  • ______ and ______.
  • Diffusely ____ without palpable nodules.
  • The over-activity of Graves’ disease is demonstrated on ultrasound by the _____ vascularity seen with ____ Doppler (termed “____ ____”).
53

Swelling; tenderness

Infection; autoimmune

de Quervain’s; Hashimoto’s

Thyroiditis:

  • Characterized by _____ and _____ of the gland.
  • Usually caused by ____, but can be related to _____ abnormalities.
  • There are two types of thyroiditis: _____ and _____
54

Infection

Inflammation; tenderness

Gradual; abrupt

Temporary

de Quervain’s Thyroiditis:

  • Thought to be caused by a thyroid _____.
  • Results in diffuse ____ of the thyroid with enlargement and _____.
  • The disease can have a ___ or ____ onset.
  • There may be severe pain.
  • May cause _____ hyperthyroidism.
  • Usually within a few weeks or months, the swelling and pain go away and the gland goes back to functioning normally.
55

Heterogeneous

Lobulated

Sonographic Findings of de Quervain’s Thyroiditis:

  • _____ thyroid tissue
  • ____ thyroid contour
56

Most common; thyroiditis

Autoimmune; inflammation

Painless

Young; middle

Symmetric

Hashimoto’s Thyroiditis:

  • The ___ ____ form of ____.
  • Characterized by a destructive ____ disorder which leads to chronic _____ of the gland.
  • This form of thyroiditis usually _____. Some patients may have mild to moderate tenderness
  • Usually seen in ____ or ____ aged women.
  • The entire gland is involved in the inflammatory process, however enlargement is not always ____.
57

Hypoechoic

Enlarged

Coarse

Hypoechoic; fibrous

Sonographic Findings of Hashimoto’s Thyroiditis:

  • The gland may appear _____
  • May appear ____
  • The texture is usually ____
  • Multiple ill-defined _____ areas separated by thickened ____ strands may be imaged.
58

Not

Increased

Fibrotic; ill-defined; heterogeneous

Increased; malignant

Sonographic Findings of Hashimoto’s Thyroiditis:

  • Discrete thyroid nodules are ____ commonly seen.
  • Color Doppler will show ____ vascularity.
  • Over time, the gland will become ___, _____, and _____.
  • There is an ____ risk for ____ disease associated with Hashimoto’s disease.