24 Neoplastic - Endocrine Flashcards
What percent of thyroid CA are well diff
> 90%
What percent of thyroid nodules are malig
<5%
What percent of thyroid nodules are malig in pts w/ h/o RT exposure
30-50%
What is the avg lag time b/w radiation exposure and development of thyroid CA
15-25 yrs
What is m/c thyroid nodule
Follicular adenoma
What is significance of age with thyroid nodules
More likely to be malig in women over 50 and men over 40 and in both men and women under 20
What percent of solitary thyroid nodules in kids are malig
50%
What is significance of size w/ thyroid nodules
more likely to be malig if >4 cm
What is diff in incidence of malig b/w solitary and multiple nodules
5-12%; 3%
What percent of malig thyroid nodules are suppressible by exogenous TSH
16%
What percent of benign thyroid nodules are suppressible by exogenous TSH
21%
What are the 3 types of well-diff thyroid malig
Papillary, Follicular, Hurthle cell
What thyroid CA is a/w iodine deficiency
Follicular
Which thyroid CA is more likely to be seen in a 30 yo
Papillary
Which thyroid CA is more likely to be seen in a preg woman
Follicular
Which thyroid CA has best prog
Papillary
Which well-diff thyroid CA is relatively unresponsive to ablation with RAI
Hurthle cell
65 yo F p/w cervical LN. FNA shows well-diff thyroid tissue. Thyroid has no palpable abnlity. What is next step?
Total thyroid and ND
What factor best correlates with the presence of LN mets in papillary CA
Age
T/F: Microscopic LN involvement does not change the long-term survival in pts with papillary thyroid CA
True
What is the incidence of multicentric dz on path exam of entire thyroid in pts with papillary CA (>1 cm)
70-80%
What histo subtypes of thyroid tumors are a/w an inc risk of local recurrence and mets
Tall cell, columnar, insular, solid variant, and poorly diff
“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?
No
M/c site of mets from follicular thyroid CA
bone
How is the definitive dx of follicular thyroid CA made
capsular invasion at the interface of the tumor and the thyroid gland
What is the most imp prognostic factor of follicular thyroid CA
degree of angioinvasion
T/F: Follicular cell CA is more aggressive than Hurthle cell
False
What is the incidence of pts with Hurthle cell CA who present with distant mets
15%
What are the 3 most well known prognostic systems for well diff thyroid CA
GAMES
AMES
AGES
What are the indications for adjuvant thyroid hormone in pts with well-diff thyroid CA
All pts w/ WDTC should be tx with thyroid hormone to suppress TSH for life, regardless of extent of surgery
In what 4 settings does MTC arise?
Which have best and worst prognosis
sporadic (worst prog)
familial (best prog)
in a/w MEN IIa or IIb
Which type of MTC tends to occur unilaterally
Sporadic
Which of the MTC types presents earliest
MEN IIb (mean age 19(
What percent of MTC is sporadic
70-80%
What are the characteristics of familial MTC
Auto Dom; not a/w any other endocrinopathies
What d/o present in MEN IIa
MTC
Phenochromocytoma
Parathyroid hyperplasia
Mean age of presentation in MTC from MEN IIa
27
T/F: All pts w/ MEN IIa will have MTC
True
What d/o present in MEN IIb
MTC
Pheochromocytoma
Multiple mucosal neuromas
Marfanoid body habitus
What percent of MTC secrete CEA
50%
Genetic mutation a/w MTC
RET mutation
When is ppx thyroidectomy recommended in pts w/ RET
age 5 or 6
What is the surgical tx for MTC
Total thyroid, CCND, IPSI ND
What percent of pts have had WDTC before developing anaplastic thyroid CA
47%
What percent of pts have had benign thyroid dz before developing anaplastic thyroid CA
53%
What are the 2 types of anaplastic thyroid CA
large cell (more common) and small cell (unresponsive to radiation)
Tx for anaplastic
debulking and trach for palliation of airway obstruction
Tx for primary Non-hodgkin’s lymphoma of thyroid
CRT
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?
Total thyroidectomy should be considered bc there is an inc chance of malig in large cysts
56 yo M with no RF p/w thyroid nodule. FNA nondiagnostic. Tx of choice?
thyroid lobe
Indications for postop RAI
- 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
T/F: Multifocal WDTC < 1 cm w/o high risk features do not require postop RAI
True
Which med improves QOL when preparing pts for radioiodine scanning and ablation rx
Recombinant TSH stimulation (rTSH)
How are pts w/ MTC managed postop
Receive L-thyroxine and 2 wks of Ca and Vit D supplementation
Serial measures of calcitonin and CEA
