Benign Lesions of Thyroid MCQs

Explanation: Thyroid enlargement can compress adjacent structures, producing multiple clinical manifestations. Hoarseness of voice due to recurrent laryngeal nerve compression (Option A): The recurrent laryngeal nerve runs posteromedial to the thyroid. Compression may cause hoarseness , vocal cord paresis, or paralysis. Dysphagia due to esophagus compression (Option B): The esophagus lies medial and posterior to the thyroid. Compression can lead to difficulty swallowing or dysphagia. Superior vena cava syndrome (Option C): Although the SVC is located in the superior mediastinum and is rarely affected, large substernal goiters or massive thyroid enlargements can rarely cause SVC compression, leading to facial and upper limb edema, dyspnea, and facial plethora.

Antithyroid drugs Those in common use are carbimazole and propylthiouracil : these are ANTI-TPO drugs. Antithyroid drugs are used to restore the patient to a euthyroid state and to maintain this for a prolonged period in the hope that a permanent remission will occur, i.e. that production of TSH-RAb will diminish or cease. Propylthiouracil has no teratogenicity effect. Antithyroid drugs cannot cure a toxic nodule. The overactive thyroid tissue is autonomous and recurrence of the hyperthyroidism is certain when the drug is discontinued. Anti-thyroids in pregnancy: 1 st trimester: propylthiouracil is used (carbimazole not used because it's teratogenic and may cause aplasia cutis) 2 nd trimester onwards: carbimazole (propylthiouracil not used throughout pregnancy due to risk of hepatitis)

Thyroid scintigraphy is performed using either technetium-99m pertechnetate or a radiolabelled iodine nuclide (typically 123I or 131I). Depending on the specific study, the tracer can be administered intravenously, orally, or via inhalation, and images are obtained anywhere from 30 minutes (for intravenous [IV] injection) to 24 hours (for oral administration) afterward. The thyroid normally displays symmetric uptake bilaterally. Nodular disease can be classified into whether there is increased focal uptake (the so-called "hot" nodule) or not (the "cold" nodule). Classically, "hot" nodules in the setting of hyperthyroidism are thought to be benign toxic nodules with extremely low risk of malignancy, whereas "cold" nodules carry a 15% risk of malignancy. Reference : Sabiston textbook of Surgery, chapter: 37, Edition: 21 st , Pg: 882

Explanation: Creatinine clearance Indications for Parathyroidectomy: Serum calcium > 0.25 mmol/L (1.0 mg/dL) above the upper limit of normal. (Option A ruled out) Bone Mineral Density (BMD) by DEXA : T-score ≤ -2.5 at the lumbar spine, total hip, femoral neck, or distal one-third of radius . Vertebral fracture . Creatinine clearance 60 mL/min . 24-hour urinary calcium > 10 mmol/dL (>400 mg/day) (Option B ruled out) or increased risk of stone formation Age

Explanation: Type 3 branchial fistula passes between the internal and external carotid arteries and may open into the lateral pharyngeal wall or reach the skull base. It does not open on the cricopharyngeus muscle. Explanation of other options: Cystic hygroma is filled with clear lymph (Option B): Correct. It is a congenital lymphatic malformation. Thyroglossal cyst moves upwards on swallowing and tongue protrusion (Option C): Correct. Classical clinical sign due to attachment to the tongue. Fluctuation is positive in branchial cyst (Option D): Correct. Branchial cysts are fluctuant swellings, often soft and sometimes transilluminant.

C i.e. 99 - Tc - DMSA DTPA (Renogram) DMSA (Isotope Scanning) - DTPA is freely filtered at - Tc.99 DMSA is used for renal glomerulus with no morphological tubular reabsorption or (anatomic) imagine excretion (i.e. GFR = - This compound gets fixed in renal Excretory function) tubules & images - DTPA is useful for evaluating may be obtained after 1-2 hours of perfusion and injection. Lesions excretory function of each such as tumors & benign lesions as kidneyQ cysts show filling - Indications:defectQ

All Bethesda categories were included in the present study. The parameter used to determine the satisfactoriness of the specimens was the presence of at least six clusters of thyroid follicular cells , with each cluster including at least 10 follicular cells with good preservation . All specimens were obtained by an endocrinologist and without using ultrasound. The prepared slides were stained with the Papanicolaou stain . The histological diagnoses were classified into three types: Benign and nonneoplastic, Benign and neoplastic, and Malignant. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707785/

Some tumours are familial and account for 10–20% of all cases. Medullary carcinoma may occur in combination with adrenal phaeochromocytoma and hyperparathyroidism (HPT) (usually due to hyperplasia) in the syndrome known as multiple endocrine neoplasia type 2A (MEN-2A). The familial form of the disease frequently affects children and young adults, whereas the sporadic cases occur at any age with no sex predominance. When the familial form is associated with prominent mucosal neuromas involving the lips, tongue and inner aspect of the eyelids, with a Marfanoid habitus, the syndrome is referred to as MEN type 2B. Reference : Bailey & Love's short practice of surgery, chapter: 55, Edition: 28th, Pg: 870-871