Thyroid / parathyroid

You are seeing your patient for her 2-year follow-up after total thyroidectomy for a T1 N0 M0 papillary thyroid cancer. You note that her thyroglobulin has increased from undetectable (<0.1) to 1.1 within 1 year and similar TSH levels. Which of the following is the most appropriate next step in management?

• Indium-octreotide scintigraphy

• PET scan to assess for metastasis

• Thyroid hormone withdrawal to evaluate stimulated thyroglobulin levels

• Computed tomography with IV contrast to evaluate for local and distant metastasis

• Us of the neck

In patients with pseudohypoparathyroidism, associated findings include

• reduced parathyroid hormone levels

• target tissue resistance to parathyroid hormone

• abnormally sensitive parathyroid function

• normal skeletal development

• paradoxic hypercalcemia

A 35-year-old woman presents with palpitations, anxiety, and insomnia. Recently postpartum, she is currently breastfeeding. What are your treatment

• Alpha blockade

• Beta blockade

• Propylthiouracil

• Levothyroxine

The administration of ^99mtechnetium sestamibi

• should be reserved for patients with suspected mediastinal parathyroid glands

• can be used to ablate residual metaplastic parathyroid tissue

• can be useful to localize abnormal parathyroid glands

• should be avoided in patients with pheochromocytoma

• is based on the ability of normal parathyroid glands to take up sestamibi to a greater extent than abnormal glands

Which of the following patients with thyroid gland enlargement is LEAST likely to have a diagnosis of thyroid cancer?

• An elderly man with a solitary nodule and hoarseness

• A young man with normal thyroid tissue in a biopsy specimen of a lateral cervical lymph node

• An adolescent boy with an asymptomatic solitary nodule

• A middle-aged woman with a solitary nodule and a history of radiation therapy to the neck

• A middle-aged woman with a multinodular goiter and dysphagia

Lower glands are typically medial to the nerve, near the lower pole of the thyroid gland and tend to be anterior or superficial in the neck. Upper glands are lateral to the nerve, deep in the neck, and often are found near the tubercle of Zuckerlandl. The recurrent nerve is typically found in the tracheo-esophageal groove. Sometimes, upper glands can be found in the retroesophageal location, but this would be atypical for an inferior gland.

• Medial to the recurrent laryngeal nerve

• Lateral to the recurrent laryngeal nerve

• Posterior to the esophagus

• Near the tubercle of Zuckerkandl

A 40-year-old woman has a 2-cm nodule in the left lobe of the thyroid gland. She is euthyroid. Fine-needle aspiration yields indeterminate cytology

• exogenous thyroid hormone suppression

• left thyroid lobectomy

• repeat fine-needle aspiration

• observation and careful follow-up

• total thyroidectomy

A 26-year-old man is found to have a 1.8-cm left thyroid nodule. Neck ulltrasound is unremarkable. Fine needle aspiration reveals a follicular lesion. What is the appropriate surgical management for this patient?

• Total thyroidectomy

• Reassurance and no further intervention

• Total thyroidectomy with left central neck dissection

• Left thyroid lobectomy

Calcitonin is

• administered orally when used clinically

• given to increase the serum calcium level in hypocalcemic patients

• a part of the amine- or peptide-secreting system

• used to monitor recurrence of follicular carcinoma of the thyroid gland

• produced by the delta cells of the thyroid gland

A 37-year-old female is found to have a 0.7-cm right thyroid nodule. An FNA is performed and reveals an indeterminate follicular lesion. A right thyroid lobectomy is then performed. The right recurrent laryngeal nerve and both right parathyroid glands are identified and preserved. Postoperatively, she does well and is discharged home the next day. In follow up in the office after 10 days, pathology reveals no malignancy in the specimen. On further questioning, she reports fatigue. Which of the following laboratory tests should be ordered?

• Intact parathyroid hormone

• Complete blood count

• Thyroid stimulating hormone (thyrotropin)

• Calcium

• Vitamin D