Thyroid

What percentage of solitary thyroid nodules in children are malignant?
1. 10 Percent
2. 25 Percent
3. 50 Percent
4. 75 Percent
What is the most common of the four main types of solitary cold thyroid nodule in children?
1. Papillary thyroid cancer
2. Follicular adenoma
3. Follicular carcinoma
4. Colloid nodule
True or false: It is rare for children to have autonomous hyperfunctioning thyroid nodules that are hot?
1. True
2. False
Can pediatric papillary thyroid cancer be cystic?
1. True
2. False
Lymph node metastases are (common or uncommon) in papillary thyroid cancer in children?
1. Common
2. Uncommon
Occult papillary thyroid carcinoma is (more or less common) in children versus adults?
1. More common
2. Less common
How you make the diagnosis of Hashimoto's thyroiditis?
1. Only by biopsy
2. Circulating antimicrosomal Antibodies
3. Huthle cells are present
True or false: in kids, hyperfunctional thyroid nodules are rare, but almost uniformly benign?
1. True
2. False
Is fine needle aspiration biopsy of the thyroid useful in children?
1. True
2. False
Is a period of attempted suppression of a well-defined nodule a useful technique in children?
1. Yes
2. No
True or false: the incidence of thyroid cancer in children has dramatically increased over the last four decades?
1. True
2. False
What percentage of childhood thyroid cancer is papillary?
1. 50 percent
2. 70 percent
3. 90 percent
4. 98 percent
What type of thyroid cancer is associated with radiation exposure?
1. Papillary
2. Follicular
3. Mixed Papillary and Follicular
4. Anaplastic
What percentage of children with papillary thyroid carcinoma present with a palpable thyroid nodule?
1. Under 10 Percent
2. Under 25 Percent
3. Under 50 Percent
4. Under 75 Percent
How is papillary thyroid cancer usually diagnosed?
1. Clinically enlarged lymph nodes
2. Thyroid nodule
3. Either of the above
4. Hyperthyroidism
How you manage a cold nodule in a child?
1. Total thyroidectomy
2. Subtotal thyroidectomy
3. Lobectomy
4. Nodulectomy
Is a central node dissection (from the hyoid bone to the sternal notch) recommended with papillary thyroid cancer in children?
1. Yes
2. No
What is the only indication for resection of the recurrent laryngeal nerve in children with papillary cancer of the thyroid?
1. Hoarseness preoperatively
2. Documented preop paralysis and direct cord invasion by tumor
3. Perineural involvement
Which is NOT part of the management of papillary thyroid cancer after total thyroidectomy and lymph node resection?
1. Immediate thyroid hormone suppresion
2. I 131 scan in 6 weeks
3. Therapeutic radioiodine if positive scan
What is the maximum total dose of iodine 131 that can be administered?
1. 50 millicuries
2. 100 millicuries
3. 200 millicuries
4. 600 millicuries
True or false: children under 7 years may have more extensive involvement with papillary thyroid cancer, disease that cannot be totally eradicated with a total thyroidectomy, lymph node resection, and I 131 therapeutic dosage. (As opposed to children older than 7 years, in which case in disease usually able to be totally eliminated)?
1. True
2. False
Follicular carcinoma of the thyroid in children is uncommon, slow-growing, and the prognosis depends largely on what?
1. Nodal involvement
2. Capsular invasion
3. Distant metastases
4. Elevated thyrocalcitonin
True or false: vascular invasion is common in follicular carcinoma of thyroid?
1. True
2. False
What is the false negative rate for needle aspiration of the thyroid gland in medullary carcinoma of the thyroid?
1. 10 Percent
2. 25 Percent
3. 50 Percent
4. 75 Percent
Where does medullary carcinoma of the thyroid originate from?
1. Parafollicular C cells
2. 4th Branchial arch
3. Chief cells
4. Hurthle cells
What is Sipple's syndrome?
1. MEN I
2. MEN II A
3. MEN II B
T or F: MEN IIB is 50 times less common than MEN II A?
1. True
2. False
Does medullary carcinoma of the thyroid behave more aggressively for MEN II A versus MEN II B?
1. True
2. False
What percentage of kids with medullary carcinoma of the thyroid and MEN syndromes are female?
1. 10 Percent
2. 25 Percent
3. 50 Percent
4. 75 Percent
When C-cell hyperplasia is present in a palpable thyroid nodule, what is usually present?
1. MEN II A
2. MEN II B
3. Metatstatic disease
4. Hypercalcemia
Is the prognosis for medullary carcinoma for thyroid worse if there is clinically positive disease versus a silent, asymptomatic child who is only identified by positive calcitonin test?
1. True
2. False
Medullary carcinoma of thyroid is always bilateral and always what?
1. Metastatic to distant site
2. Multicentric
3. Associated with MEN II A or B
4. Associated with LN metastases
What is the surgical treatment of medullary carcinoma of thyroid?
1. Lobectomy
2. Subtotal thyroidectomy
3. Total thyroidectomy
4. Total thyroidectomy with central node dissection
True or false: sporadic medullary carcinoma of thyroid usually involves only one lobe, but still requires total thyroidectomy and a central lymph node resection?
1. True
2. False
In isolated medullary carcinoma of thyroid without C-Cell hyperplasia, an extensive evaluation of other family members is still necessary?
1. True
2. False
If lateral nodes are involved with medullary carcinomas of thyroid, is the prognosis worse?
1. True
2. False
Graves' disease (hyperthyroidism) accounts for what percent of thyroid disorders in childhood?
1. 5 Percent
2. 10 Percent
3. 15 Percent
4. 25 Percent
What percentage of goiters in childhood are associated with hyperthyroidism?
1. 10 Percent
2. 33 Percent
3. 66 Percent
4. 75 Percent
Graves' disease is rare in infants: what is the mortality if it occurs?
1. 10 Percent
2. 25 Percent
3. 50 Percent
4. 75 Percent
Which is NOT a symptom of hyperthyroidism in children?
1. Hypertension
2. Tachycardia
3. Accelerated growth
4. Weight gain
How is the diagnosis of Graves' disease distinguished from Hashimoto's thyroiditis on radioiodine scan?
1. Graves shows increased diffuse uptake
2. Hashimotos shows decreased uptake
3. Scans are similar for both
What is the TSH level usually seen in a patient with Graves' disease?
1. Elevated
2. Normal
3. Decreased
What percentage of children, and overall, remain hyperthyroid after 2 years of medical therapy for Graves' disease?
1. 50 Percent
2. 75 Percent
3. 95 Percent
Who is at higher risk for failure of long-term medical management for Graves' disease?
1. Children under 5 yrs
2. Adolescent females
3. Males older than 11 yrs
4. Initial thyromegaly
For subtotal thyroidectomy in Graves, how long is beta-blockade given preoperatively?
1. 2 days
2. 1 week
3. 1 month
4. 2 months
Which is safer for Graves' disease; take out too much thyroid or take out too little thyroid?
1. Take too much
2. Take too little
3. Both are associated with equal problems
What is the benefit of a complete thyroid resection for Graves' disease?
1. Lower complication rate
2. May relieve progressive opthalmopathy
3. Avoids cancer risk associated with radiation
What is the treatment of Graves' ophthalmopathy?
1. Steroids
2. Decompressive surgery
3. Both
4. Neither
True or false: iodine 131 for Graves' disease does increase their risk of leukemia, infertility, and congenital malformations in their offspring?
1. True
2. False
What percentage of patients with a lingual thyroid have no thyroid tissue elsewhere?
1. 20 Percent
2. 33 Percent
3. 60 Percent
4. 75 Percent
True or false: ectopic thyroid tissue is often poorly functional or nonfunctional?
1. True
2. False
True or false: ectopic thyroid extending too far down into the mediastinum or pericardium usually does have normal functional thyroid tissue in neck?
1. True
2. False
Autoimmune chronic thyroiditis (Hashimoto's disease) is how much more common in females than males?
1. 2 times as common in females
2. 10 times as common in females
3. 40 times as common in females
True or false: Hashimoto's disease may be triggered by stress?
1. True
2. False
What mediates cellular damage in Hashimoto's disease?
1. Antithyroid antibody dependent
2. Direct cytotoxicity from T cells
3. Both
4. Neither
How is Hashimoto's disease classified?
1. Vascular invasion
2. Titer of antithyroid antibodies
3. Amount of fibrosis
How do children with Hashimoto's disease commonly present?
1. Most are asymptomatic
2. Painful enlargement
3. Thyrotoxicosis
4. Hoarseness
How is the diagnosis of Hashimoto's disease made?
1. Radioiodine scan
2. Biopsy
3. PCR
4. Titer of thyroid antibodies
T or F: In both transient thyrotoxicosis occasionally seen in Hashimoto's disease and Graves' disease, exopthalmos may be seen?
1. True
2. False
True or false: Graves' disease has increased thyrotropin receptor antibodies?
1. True
2. False
What is the initial treatment of symptomatic Hashimoto's disease?
1. Thyroid hormone suppression
2. Subtotal thyroidectomy
3. Propothiouracil
4. Radioiodine
Is there any increased incidence of thyroid cancer in patients with Hashimoto's disease?
1. Yes
2. No
Which type of thyroiditis in children is most likely viral in origin?
1. Acute thyroiditis
2. Chronic thyroiditis
3. Subacute thyroiditis
T or F: Gender variation in childhood versus adult thyroiditis is M:F = 1:2 versus 1:10 in adults?
1. True
2. False
Which type of thyroiditis in children is most likely autoimmune in origin?
1. Acute thyroiditis
2. Chronic thyroiditis
3. Subacute thyroiditis
Granulomatous subacute thyroiditis (deQuervain's and Riedel's thyroiditis) are rare in children, and are treated how?
1. Thyroid hormone suppression
2. Subtotal thyroidectomy
3. Propothiouracil
4. Radioiodine
Acute thyroiditis presents and is treated how?
1. Thyroid hormone suppression
2. Subtotal thyroidectomy
3. Radioiodine
4. None of the above
What distinguishes children with subacute thyroiditis from those with Hashimoto's disease?
1. Hashimotos is associated with systemic symptoms
2. Subacute thyroiditis has positive antibodies
3. Subacute thyroiditis has systemic symptoms
True or false: children with subacute thyroiditis may develop permanent hypothyroidism?
1. True
2. False
Most childrenÂ’s goiters are (hypothyroid or hyperthyroid)?
1. Hypothyroid
2. Hyperthyroid
3. Euthyroid
Which is NOT a cause of goiter?
1. Excessive thyroid hormone receptors
2. Iodine organification defect
3. Iodotyrosine coupling defect
4. Iodotyrosine de-iodination defect
True or false: long-term thyroid hormone replacement will always cause goiters to regress?
1. True
2. False
When is thyroidectomy indicated for the treatment of goiter?
1. Compression symptoms or cosmetic reasons
2. Persistent hyperthyroidism
3. Both of above
PendredÂ’s syndrome is associated with a goiter and what?
1. Papillary thyroid cancer
2. Deaf-mutism
3. Both
4. Neither
Endemic goiter is due to deficiency of what?
1. Thyroid hormone
2. Iodine
3. Both
T or F: Neonatal hyperparathyroidism can cause life-threatening hypercalcemia within the first few days of life?
1. True
2. False
What are the genetics of neonatal hyperparathyroidism?
1. X - linked recessive
2. Autosomal dominant
3. Autosomal recessive
4. Unknown
At what age is benign FHH - familial hypocalciuric hypercalcemia - seen in children?
1. Under 5 yrs of age
2. 5 - 10 yrs of age
3. Older than 10 yrs of age
4. After about 16 yrs of age
True or false: familial hyperparathyroidism is more common in children than in adults?
1. True
2. False
What is the earliest manifestation of MEN I?
1. Renal osteodystrophy
2. Thyroid nodule
3. Hyperparathyroidism
4. Peptic ulcers
In children with hyperparathyroidism secondary to MEN I, how much parathyroid tissue is left behind?
1. 2 mg
2. 40 - 50 mg
3. 2 - 3 gms
4. 1 normal gland
What percentage of patients are left permanently hypoparathyroid after total parathyroidectomy with autotransplant?
1. 5-10 percent
2. 10-20 percent
3. 40-50 percent
4. 60-75 percent
True or false: the chief cell hyperplasia seen in MEN II A is not as severe as that seen in MEN I?
1. True
2. False
What is the surgical treatment of hyperparathyroidism associated with MEN IIB?
1. Subtotal parathyroidectomy
2. Total parathyroidectomy and autotransplantation
3. Either of the above is adequate
4. Nothing
What is the primary cause of hyperparathyroidism in adolescence?
1. Adenoma
2. Diffuse hyperplasia
3. Parathyroid carcinoma
4. MEN syndrome
Hyperplastic parathyroid glands have decreased or increased intracellular fat?
1. Increased fat
2. Decreased fat
True or false: sporadic parathyroid adenoma may be due to neck irradiation 20 years or more previously?
1. True
2. False
What is NOT a cause of secondary hyperparathyroidism?
1. Vit D abnormalities
2. Hypercalcemia
3. Chronic renal insufficiency
4. Aluminum toxicity
What is the surgical treatment for secondary hyperparathyroidism, and who is a candidate for operation?
1. Subtotal parathyoidectomy
2. Excision of the enlarged gland
3. Total parathyroidectomy
True or false: an increase in C-terminal PTH suggests tertiary hyperparathyroidism after renal transplant; all glands may be enlarged, and subtotal parathyroidectomy is the treatment?
1. True
2. False

Thyroid

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