Chapter 15 Thyroid and Parathyroid Surgery


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Chapter 15  Thyroid and Parathyroid Surgery



Complete chapter Questions And Answers

Sample Questions




1. The pyramidal lobe of the thyroid is described as:

  1. a small lobe often involved in 30% of cases of thyroid dysfunction.
  2. a protrusion of an immature thyroglossal duct cyst overgrowth.
  3. a thin upward protrusion of thyroid tissue from the isthmus.
  4. a vestige of an embryonic thyroid cyst.

The pyramidal lobe, a long, thin projection of thyroid tissue protruding cephalad from the isthmus, is found in about 30% of patients at surgery; it is the vestige of the embryonic thyroglossal duct and migrates from the foramen cecum at the base of the tongue. If the migratory tract fails to degenerate, a fistula or cyst may be present.

REF: Page 566

2. The primary function of the three thyroid hormones is to regulate:

  1. energy metabolism.
  2. body growth and development.
  3. calcium storage in the bones.
  4. the decrease in blood calcium levels.

The thyroid gland produces three hormones: thyroxine (T4) and triiodothyronine (T3) (together known as the thyroid hormones [THs]) and calcitonin. T3 and T4 cannot be synthesized without iodine. Calcitonin increases calcium storage in the bone and decreases blood calcium levels. The primary function of thyroid hormones is to regulate energy metabolism, but they also play an important role in growth and development. Thyroid-stimulating hormone (TSH) is synthesized by the anterior pituitary, and stimulates the production and release of thyroid hormones and the uptake of iodine.

REF: Page 566

3. Postoperative hoarseness, obstructed airway, or paralysis of the vocal cords is a serious complication of thyroid surgery. During surgery, care is taken to identify and protect which nerve?

  1. Superior branch of the vagus nerve
  2. Intrinsic cricothyroid nerve
  3. Recurrent tracheoesophageal nerve
  4. Recurrent laryngeal nerve


Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 15-2

The recurrent laryngeal nerve, a branch of the vagus nerve, innervates the intrinsic muscles of the larynx. During surgery, care is taken to identify and protect this nerve. Immediate hoarseness occurs if the nerve is divided on one side. If the recurrent nerve is injured bilaterally, acute paralysis of both vocal cords may obstruct the airway and require emergency tracheotomy. Injury to the external branch of the superior laryngeal nerve, which innervates the cricothyroid muscle, results in difficulty shouting or singing high notes.

REF: Page 566

4. What is the mechanism by which the parathyroid glands maintain calcium homeostasis?

  1. They secrete parathyroid hormone (PTH), which promotes calcium storage in the


  2. They produce a hormone that, with calcitonin, takes calcium from the bones and

    promotes calcium absorption by the intestines.

  3. They stimulate the pituitary to produce PTH and calcitonin, which elevates serum

    calcium levels.

  4. They secrete hormones that stimulate the production of calcium in the bones and

    small intestines when serum calcium levels fall below 4.5 mg/dl.

The parathyroid glands secrete parathyroid hormone (PTH), an antagonist to calcitonin. Both PTH and calcitonin work together to maintain calcium homeostasis by increasing calcium removal from storage in bone and increasing absorption of calcium by the intestines.

REF: Pages 567, 572

5. The preoperative testing regimen for diagnosing thyroid disorders follows a structured plan of history taking, neck palpation, imaging scans, and fine needle aspiration. Select the statement from that is an appropriate reflection of a thyroid diagnostic study.

  1. Palpation determines size, contour, swallowing function, lymph nodes, and bruits.
  2. Fluoroscopy-guided fine needle aspiration is typically performed for frozen


  3. Ultrasonic scans are the treatment of choice to evaluate thyroid nodules.
  4. MRI and CT scans evaluate local invasion of the tumor nodules within the thyroid


Ultrasonic scans evaluate thyroid nodules and are useful to determine the size and
number of nodules within the thyroid as well as to monitor size progression during follow-up. In addition to palpation of the thyroid gland for size, contour, consistency, lymph nodes, fixation, tenderness, and bruits, scans are used to clarify thyroid anatomy. CT and MRI scans are used to assess a thyroid with suspected malignancy for encroachment of the tumor outside the thyroid capsule into the adjacent tissue of the neck. Scans are the most effective means to evaluate local invasion of surrounding tissue. Fine needle aspiration is usually performed under ultrasound guidance. Several samples are aspirated from various parts of the nodule.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 15-3

REF: Pages 571-572

6. Hypothyroidism results from undersecretion of thyroid hormone. The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis (Hashimoto’s disease). Select the set of symptoms that is most commonly associated with hypothyroidism.

  1. Dry skin, edema, constipation, and depression
  2. Irritability, mood changes, visual disturbances, and diarrhea
  3. Heat intolerance, anorexia, hair loss, and menstrual irregularity
  4. Bradycardia, hypotension, hypoxia, and poor concentration

Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, hair dryness or loss, dry skin, depression, hoarse voice, poor concentration, muscle stiffness and pain, edema, bradycardia, constipation, and menstrual irregularity (especially heavy menses; infertility).

REF: Page 571

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