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Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions > 24 Neoplastic - Endocrine > Flashcards

24 Neoplastic - Endocrine Flashcards

1
Q

What percent of thyroid CA are well diff

A

> 90%

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2
Q

What percent of thyroid nodules are malig

A

<5%

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3
Q

What percent of thyroid nodules are malig in pts w/ h/o RT exposure

A

30-50%

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4
Q

What is the avg lag time b/w radiation exposure and development of thyroid CA

A

15-25 yrs

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5
Q

What is m/c thyroid nodule

A

Follicular adenoma

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6
Q

What is significance of age with thyroid nodules

A

More likely to be malig in women over 50 and men over 40 and in both men and women under 20

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7
Q

What percent of solitary thyroid nodules in kids are malig

A

50%

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8
Q

What is significance of size w/ thyroid nodules

A

more likely to be malig if >4 cm

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9
Q

What is diff in incidence of malig b/w solitary and multiple nodules

A

5-12%; 3%

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10
Q

What percent of malig thyroid nodules are suppressible by exogenous TSH

A

16%

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11
Q

What percent of benign thyroid nodules are suppressible by exogenous TSH

A

21%

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12
Q

What are the 3 types of well-diff thyroid malig

A

Papillary, Follicular, Hurthle cell

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13
Q

What thyroid CA is a/w iodine deficiency

A

Follicular

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14
Q

Which thyroid CA is more likely to be seen in a 30 yo

A

Papillary

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15
Q

Which thyroid CA is more likely to be seen in a preg woman

A

Follicular

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16
Q

Which thyroid CA has best prog

A

Papillary

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17
Q

Which well-diff thyroid CA is relatively unresponsive to ablation with RAI

A

Hurthle cell

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18
Q

65 yo F p/w cervical LN. FNA shows well-diff thyroid tissue. Thyroid has no palpable abnlity. What is next step?

A

Total thyroid and ND

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19
Q

What factor best correlates with the presence of LN mets in papillary CA

A

Age

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20
Q

T/F: Microscopic LN involvement does not change the long-term survival in pts with papillary thyroid CA

A

True

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21
Q

What is the incidence of multicentric dz on path exam of entire thyroid in pts with papillary CA (>1 cm)

A

70-80%

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22
Q

What histo subtypes of thyroid tumors are a/w an inc risk of local recurrence and mets

A

Tall cell, columnar, insular, solid variant, and poorly diff

23
Q

“A 36-year-old woman presents with a 3 cm papillary carcinoma and no clinical evidence of lymph node involvement, no intrathyroidal vascular invasion, and no gross or microscopic multifocal disease. She has no history of neck radiation and no family history of thyroid cancer. She was treated with a total thyroidectomy. Is radioiodine ablation therapy indicated?

A

No

24
Q

M/c site of mets from follicular thyroid CA

A

bone

25
Q

How is the definitive dx of follicular thyroid CA made

A

capsular invasion at the interface of the tumor and the thyroid gland

26
Q

What is the most imp prognostic factor of follicular thyroid CA

A

degree of angioinvasion

27
Q

T/F: Follicular cell CA is more aggressive than Hurthle cell

A

False

28
Q

What is the incidence of pts with Hurthle cell CA who present with distant mets

A

15%

29
Q

What are the 3 most well known prognostic systems for well diff thyroid CA

A

GAMES
AMES
AGES

30
Q

What are the indications for adjuvant thyroid hormone in pts with well-diff thyroid CA

A

All pts w/ WDTC should be tx with thyroid hormone to suppress TSH for life, regardless of extent of surgery

31
Q

In what 4 settings does MTC arise?

Which have best and worst prognosis

A

sporadic (worst prog)
familial (best prog)
in a/w MEN IIa or IIb

32
Q

Which type of MTC tends to occur unilaterally

A

Sporadic

33
Q

Which of the MTC types presents earliest

A

MEN IIb (mean age 19(

34
Q

What percent of MTC is sporadic

A

70-80%

35
Q

What are the characteristics of familial MTC

A

Auto Dom; not a/w any other endocrinopathies

36
Q

What d/o present in MEN IIa

A

MTC
Phenochromocytoma
Parathyroid hyperplasia

37
Q

Mean age of presentation in MTC from MEN IIa

A

27

38
Q

T/F: All pts w/ MEN IIa will have MTC

A

True

39
Q

What d/o present in MEN IIb

A

MTC
Pheochromocytoma
Multiple mucosal neuromas
Marfanoid body habitus

40
Q

What percent of MTC secrete CEA

A

50%

41
Q

Genetic mutation a/w MTC

A

RET mutation

42
Q

When is ppx thyroidectomy recommended in pts w/ RET

A

age 5 or 6

43
Q

What is the surgical tx for MTC

A

Total thyroid, CCND, IPSI ND

44
Q

What percent of pts have had WDTC before developing anaplastic thyroid CA

A

47%

45
Q

What percent of pts have had benign thyroid dz before developing anaplastic thyroid CA

A

53%

46
Q

What are the 2 types of anaplastic thyroid CA

A 
large cell (more common) and 
small cell (unresponsive to radiation)
47
Q

Tx for anaplastic

A

debulking and trach for palliation of airway obstruction

48
Q

Tx for primary Non-hodgkin’s lymphoma of thyroid

A

CRT

49
Q

A 44-year-old man presents witha5cm thyroid nodule. FNA returns fluid, the nodule disappears, and the cytology is benign. What is the next step in management?

A

Total thyroidectomy should be considered bc there is an inc chance of malig in large cysts

50
Q

56 yo M with no RF p/w thyroid nodule. FNA nondiagnostic. Tx of choice?

A

thyroid lobe

51
Q

Indications for postop RAI

A
  • Known distant mets
  • Gross extrathyroidal extension of tumor
  • Tumors > 4 cm
  • Tumors 1-4 cm when T&N status/age/histo features predict an intermediate to high rate of recurrence
52
Q

T/F: Multifocal WDTC < 1 cm w/o high risk features do not require postop RAI

A

True

53
Q

Which med improves QOL when preparing pts for radioiodine scanning and ablation rx

A

Recombinant TSH stimulation (rTSH)

54
Q

How are pts w/ MTC managed postop

A

Receive L-thyroxine and 2 wks of Ca and Vit D supplementation
Serial measures of calcitonin and CEA

Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions (14 decks)

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