378 Thyroid Nodule Flashcards
1
Q
refers to an enlarged thyroid gland
A
goiter
2
Q
True or false. Graves’ disease and Hashimoto’s thyroidism are also associated with goiter
A
True
3
Q
pathogenesis of goiter in Grave’s disease
A
TRH mediated effects of thryoid stimulating immunoglobulin
4
Q
pathogenesis of goiter in Hashimoto’s thyroidism
A
goitrous form occurs because of acquired defects in hormone synthesis, leading to elevated levels of TSH and its consequent growth effects
5
Q
Diffuse enlargement of the thyroid in the absence of nodules and hyperthyroidism
A
Diffuse nontoxic goiter
6
Q
other name of diffuse nontoxic goiter
A
simple goiter, colloid goiter
7
Q
most common cause of diffuse goiter worldwide
A
iodine deficiency
8
Q
thyroid enlargement in teenagers
A
juvenile goiter
9
Q
true or false. In iodine deficient areas, thyroid enlargement reflects a compensatory effort to trap iodine and produce sufficient hormone when hormone synthesis is relatively inefficient
A
True.
10
Q
what is the action of iodine to thyroid growth
A
direct actions on thyroid vasculature and indirectly affect growth through vasoactive substances such as endothelin and nitric oxide
11
Q
abnormal thyroid volume on ultrasound
A
more than 30 ml
12
Q
refers to the facial and neck congestion due to jugular venous obstruction when the arms are raised above the head
A
Pembertons sign
13
Q
manuever that draw the thyroid to the thoracic inlet
A
Pembertons sign
14
Q
associated with Pemberton signs
A
substernal goiter
15
Q
laboratory findings that support iodine deficiency
A
low urinary iodine levels less than 50 ug/L
16
Q
True or false. Iodine replacement induces variable regression of goiter in iodine deficiency depending on the duration and degree of hyperplasia
A
True.
17
Q
conditions where surgery is indicated in diffuse goiter
A
tracheal compression or obstruction of the thoracic inlet
18
Q
True or false. Surgery is rarely indicated for diffuse goiter
A
True.
19
Q
True or false. TSH is play an permissive or contributory role in nontoxic multinodular goiter
A
True.
20
Q
True or false. Most patients with nontonic multinodular goiter are asymptomatic and euthyroid
A
True.
21
Q
What leads to hoarseness of voice in patient with goiter
A
laryngeal nerve involvement
22
Q
True or false. Pain and hoarseness of voice in goiter suggests malignancy
A
True.
23
Q
At what level can tracheal compression lead to significant airway compromise
A
Compression exceed 70% of the tracheal diameter
24
Q
sonographic features assocaited with thyroid cancer
A
hypoechoic compared with surrounding thyroid, marked hypoechogenicity, microcalcifications, irregular microlobulated margins, solid consistency, taller than wide shape on transverse view
25
characterized by enhanced thyroid production by autonomous nodules
Jod Baselow effect
26
can be used when surgery is contraindicated in areas where large nodular goiter are more prevalent
radioiodine
27
action of radioiodine in toxic nultinodular goiter
decrease MNG volume and may selectively ablate regions of autonomy
28
usual dosage of 131I
3.7 Mbq (0.1 mCi) per gram of tissue, corrected for uptake 370- 1070 Mbq (10-29 mCi)
29
administered concomitantly with 131I to increase effectiveness
TSH 0.1 mg IM
30
True or false. Spontaneous remission on toxic multinodular goiter does not occurs as compared to Graves disease so treatment is lifelong
True.
31
treatment of choice for toxic multinodular goiter
radioiodine
32
solitary autonomously functioning thyroid nodule
toxic adenoma
33
pathogenesis of toxic adenoma
mutations in the TSH-R
34
less common mutations seen in toxic adenoma
Gsa mutations
35
activating mutations identified in more than 90% of patients with toxic adenoma
active mutations in the TSH-R or Gsa
36
in hyperfunctioning solitary nodule, when is thyrotoxicosis generally detected
when nodule is more than 3 cm
37
provides definitive diagnostic test for hyperfunctioning solitary nodule
thyroid scan
38
treatment of choice for hyperfunctioning solitary nodule
radioiodine ablation
39
True or false. In hyperfunctioning thryoid nodule, medical therapy with antithyroid drug and beta blocker can normalize thyroid function but is not optimal long term treatment
True.
40
adenoma composed of oncocytic follicular cells arranaged in follicular pattern
Hurthle cell adenoma
41
what is the definition of spongiform
microcystic areas comprise more than 50% of the nodule volume
42
diagnostic procedure of choice to evaluate thyroid nodules
FNA with ultrasound guidance
43
when should levothyroxine therapy be discontinue in thyroid nodule
no decrease in size after 6-12 months of therapy
44
what is the target TSH when giving levothyroxine in patients with thyroid nodule
TSH should be maintained just the lower limit of normal
45
most common malignancy of endocrine system
thyroid cancer
46
thyroid cancer with good prognosis
papillary thyroid cancer and follicular thyroid cancer
47
thyroid cancer associated with a bleak progosis
anaplastic thyroid cancer
48
True or false. Thyroid cancer is twice as common in women as men but male gender is associated with worse prognosis
True.
49
risk factors for thyroid carcinoma in patients with thyroid nodule
history of head or neck irradiation, exposure to ionizing radiation from fallout, age less than 25 or more than 65, rapidly enlarging neck mass, male gender, family history, vocal cord paralysis, hoarseness of voice, nodule fixed to adjacent structures, lateral cervical lymphadenopathy
50
True or false. Anaplastic thyroid cancer has only one stage, Stage IV
True.
51
T3 in thyroid cancer
more than 4 cm or with tumor extention
52
T1 in thyroid cancer
T1a less than 1 cm, T1b more than 1 cm but less than 2 cm
53
T2 in thyroid cancer
More than 2 cm but not more 4 cm
54
True or false. Higher TSH levels are associated with increased thyroid cancer risk
True.
55
mutations relatively specific for thyroid neoplasm
RET/PTC, PAX8-PPAR gamma 1
56
mutations associated with loss of iodine uptake by tumor celle
BRAF V600E
57
Most common type of thyroid cancer
papillary thyroid carcinoma
58
associated with large clear nuclei with powdery chromatin with nuclear grooves and prominent nucleoli
orphan Annie eyes in PTC
59
thyroid cancer more common in iodine deficient regions
follicular thyroid cancer
60
Can follicular carcinoma be diagosed by FNA
No
61
Why cant FTC be diagnosed on FNA
distinction between benign and malignant follicular cells require histology as nuclear features of follicular adenoma and carcinomas do not differ
62
differentiate follicular carcinoma from adenoma
in carcinoma, there is presence of capsular or vascular invasion
63
Spread of PTC
lymphatics but also hematogenously
64
Spread of FTC
hematogenous
65
initial surgical procedure for thyroid cancer more than 1 cm but less than 4 cm
unilateral (lobectomy) or bilateral (near total thyroidectomy)
66
treatment for patient with high risk for recurrence
bilateral surgery and radioiodine for remnant ablation
67
True or false. Most thyroid tumor are TSH responsive
True.
68
Mainstay of thyroid cancer treatment
levothryoxine suppression of TSH
69
TSH level for those with known metastatic disease
TSH less than 0.1 mIU/L
70
TSH level for low risk of recurrence
lower normal limit 0.5-2.0 mIU/L
71
TSH level for intermediate risk for recurrence
0.1-0.5 mIU/L
72
TSH level for high risk for recurrence
less than 0.1 mIU/L
73
what is the TSH level at the time of 131I therapy
more than 25 mIU
74
Strategy of remnant ablation
one is treat patient with liothyronine 25 ug OD or BID for several weeks then hormone withdrawal for 2 week; Two is administration of recombinant human TSH (rhTSH) as two daily consecutive injections of 09 mg with administration of 131I about 24 hours after the second injection
75
sensitive marker of residual/ recurrent thyroid cancer after ablation of the residual postsurgical thryoid tissue
serum thyroglobulin
76
Where is the common recurrence of PTC
cervical lymph nodes
77
what should be performed post ablation in PTC
neck ultrasound 6 months after thyroid ablation
78
True or false. ATC has poor prognosis and most patients die within 6 months of diagnosis
True.
79
True or false. Neck ultrasound is more sensitive than whole body scan in detecting recurrences of PTC in cervical lymph nodes
True.
80
what is the risk of structural recurrence for no clinical evidence of residual disease after ablation, negative cervical sonography, and basal Tg less than 0.2 mg/ml on levothyroxine
less than 3% at 5 years
81
what is the Tg level to get 3% recurrence at 5 years
Tg less than 0.2 mg/ml
82
True or false. In ATC due to undifferentiated state of these tumors, the uptake of radioiodine is usually negligible
True.
83
Lymphoma in the thryoid gland often arise in the background of what thyroiditis
Hashimoto's thyroiditis
84
Suggests the possibility of thyroid lymphoma
rapidly enlarging thyroid mass
85
most common type of thyroid lymphoma
diffuse large cell lymphoma
86
True or false. Biopsies of thyroid lymphoma is difficult to distinguish from small cell lung cancer or ATC
True
87
True or false. Thyroid lymphoma is sensitive to external beam radiation
True.
88
Medullary cancer accounts for how much of thyroid cancer
5%
89
What are the three familial forms of medullary cancer
MEN2A, MEN2B, and familial MTC without other features of MEN
90
Which is more aggressive MEN2A vs MEN2B
MEN2B
91
Which is more aggressive, sporadic or familial MTC
familial MTC
92
in medullary thyroid cancer, which is a marker of residual or recurrent disease
serum calcitonin
93
mutations associated wit meduallary thyroid carcinoma
RET mutations
94
Primary management of MTC
surgical
95
Differential excluded in workup of RET mutations in MTC
pheochromocytoma
96
True or false. MTC tumor cells do no take up radioiodine
True.
97
Therapies that provide palliation in MTC patients
targeted kinase inhibitors and external radiation
98
What is the prevalence of palpable nodules in adults
5%
99
True or false. Most patients with thyroid nodules have normal thyroid function tests
True.
100
True or false. Lesions with increased uptake are almost never malignant
True.
101
Reasons why do a thyroid ultrasound
1. confirm is palpated mass is a nodule. 15% of palpable mass are not confirmed on ultrasound 2. assess additional nodules 3. assess the imaging pattern and size of nodule
102
recommended FNA size cutoff
1 cm
103
True or false. The 2015 ATA guidelines does not recommend FNA for any nodules less than 1 cm
True.
104
Used widely to provide more uniform terminology for reporting thyroid nodule FNA cytology results
Bethseda system
105
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. What to do next?
Diagnostic ultrasound with Lymph node assessment
106
Evaluation of thyroid nodules detected by palpation or imaging.Low TSH. What to do next?
Radionuclide scanning
107
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound. What to do next?
FNA based on size and imaging features.
108
Evaluation of thyroid nodules detected by palpation or imaging.Low TSH. Hyperfunctioning nodules. What to do next?
Evaluate and treat for hyperthyroidism
109
Evaluation of thyroid nodules detected by palpation or imaging.Low TSH. Nodule not functioning. What to do next?
Diagnostic ultrasound with Lymph node assessment
110
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound. FNA non diagnostic. What to do next?
Repeat US guided FNA
111
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound. FNA showed malignant features
Surgery
112
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound.FNA suspicious for PTC
Surgery
113
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound.FNA suspicious for follicular neoplasm?
Consider molecular testing. Surgery if indicated
114
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound.FNA atypia or follicular lesion of undetermined significance
Repeat US guided FNA or molecular testing. Surgery if indicated
115
Evaluation of thyroid nodules detected by palpation or imaging. Normal or high TSH. Nodule detected on ultrasound.FNA showed benign nodule.
Follow up.
116
What are the category in the Bethseda Classification for thyroid cytology
I nondiagnostic or unsatisfactory II benign III atypia or follicular lesion of unknown significance IV follicular neoplasm V suspicious for malignancy VI malignant
