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Endocrine Week 3 2017/18 > 4: Management of thyroid nodules > Flashcards

4: Management of thyroid nodules Flashcards

1
Q

What are the two main types of thyroid nodule?

A

Solitary thyroid nodule

Multinodular goitre

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2
Q

The vast majority of solitary thyroid nodules are ___.

A

benign

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3
Q

Who tends to develop thyroid nodules?

A

Women

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4
Q

What is the most common type of malignant thyroid nodule?

A

Papillary thyroid carcinoma

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5
Q

Papillary and ___ thyroid carcinomas are malignant epithelial tumours.

A

papillary and follicular

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6
Q

What is a malignant cancer of the parafollicular cells of the thyroid?

A

Medullary thyroid carcinoma

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7
Q

Which fascial layer contains the thyroid?

A

Pretracheal fascia

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8
Q

What happens to the thyroid when you swallow?

A

Moves up and down along with the larynx

Nodules should move up and down as well

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9
Q

Thyroid nodules are usually (painful / painless).

A

painless

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10
Q

When would a thyroid nodule be painful?

A

Usually bleeding into a cyst > expansion > nerve compression

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11
Q

What two questions must be asked on history of a thyroid lump?

A

Neck irradiation?

Family history of thyroid cancer?

helps differentiate between benign and malignant

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12
Q

What two signs must be checked for on examination of a thyroid lump?

A

Enlarged lymph nodes

papillary spreads via lymph, follicular haematogenously

Hoarseness

recurrent laryngeal nerve palsy - can be eroded by cancer

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13
Q

What are two important investigations for someone presenting with a neck lump?

A

TSH

usually normal, suppressed in hypothyroidism, solitary toxic adenoma

Ultrasound - Fine Needle Aspiration

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14
Q

How are thyroid nodules investigated?

A

Thyroid function test for TSH

Ultrasound-guided fine needle aspiration for biopsy

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15
Q

What classification systems are used to describe thyroid nodules viewed by

a) FNA
b) Ultrasound?

A

a) FNA - Thy 1 to 5

b) Ultrasound - U1 to U5

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16
Q

What else can ultrasound scanning pick up?

A

Lymphadenopathy

17
Q

What are the two surgical options for solitary thyroid nodules?

A

Lobectomy

Total thyroidectomy

18
Q

When is lobectomy advised?

A

Low risk group:

Aged < 50, tumour < 4cm

19
Q

When is total thyroidectomy advised?

A

High risk patients:

Age > 50, tumour > 4cm, TSH low

20
Q

What common staging system can be used to stage thyroid cancer?

A

TNM staging

21
Q

Following treatment of a thyroid cancer, what is the ideal TSH level?

A

Lower range of normal

You don’t want thyroid to be too metabolically active

22
Q

What is used as a marker for differentiated thyroid cancer activity after treatment?

A

Thyroglobulin

23
Q

Diagnosis of follicular thyroid carcinoma depends on what?

A

Invasion of thyroid capsule

24
Q

How does follicular thyroid carcinoma spread?

A

By blood

25
Q

Most follicular thyroid carcinomas are (invasive / minimally invasive).

A

minimally invasive

26
Q

What percentage of women are on thyroxine for autoimmune hypothyroidism?

A

5%

27
Q

What type of thyroid nodule can occur in women as a conseqeuence of long term thyroxine use?

A

Thyroid lymphoma

28
Q

Thyroid lymphomas have an (insidious / rapid) onset.

A

rapid onset

29
Q

How are thyroid lymphomas treated?

A

Steroids

Then chemo/radiotherapy

30
Q

Medullary thyroid carcinoma is a malignant cancer of the C cells which produce ___.

A

calcitonin

31
Q

What is used as a tumour cell marker in medullary thyroid carcinoma?

A

Calcitonin

32
Q

What three conditions run together in an MEN2a mutation?

A

MTC

Phaeochromocytoma

Hyperparathyroidism

33
Q

In a multinodular goitre, how is thyroid function assessed?

A

TSH

34
Q

What scan is used to assess which structures are being squashed by a multinodular goitre?

A

CT scan

35
Q

If a multinodular goitre is compressing structures, what symptoms may be produced?

How is this treated?

A

Retrosternal pain

Stridor

Orthopnoea

Surgical removal

36
Q
A

Endocrine Week 3 2017/18 (11 decks)

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