4: Management of thyroid nodules

Question 1

What are the two main types of thyroid nodule?

Answer 1

Solitary thyroid nodule

Multinodular goitre

Question 2

The vast majority of solitary thyroid nodules are ___.

Answer 2

benign

Question 3

Who tends to develop thyroid nodules?

Answer 3

Women

Question 4

What is the most common type of malignant thyroid nodule?

Answer 4

Papillary thyroid carcinoma

Question 5

Papillary and ___ thyroid carcinomas are malignant epithelial tumours.

Answer 5

papillary and follicular

Question 6

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

Answer 6

Medullary thyroid carcinoma

Question 7

Which fascial layer contains the thyroid?

Answer 7

Pretracheal fascia

Question 8

What happens to the thyroid when you swallow?

Answer 8

Moves up and down along with the larynx

Nodules should move up and down as well

Question 9

Thyroid nodules are usually (painful / painless).

Answer 9

painless

Question 10

When would a thyroid nodule be painful?

Answer 10

Usually bleeding into a cyst > expansion > nerve compression

Question 11

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

Answer 11

Neck irradiation?

Family history of thyroid cancer?

helps differentiate between benign and malignant

Question 12

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

Answer 12

Enlarged lymph nodes

papillary spreads via lymph, follicular haematogenously

Hoarseness

recurrent laryngeal nerve palsy - can be eroded by cancer

Question 13

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

Answer 13

TSH

usually normal, suppressed in hypothyroidism, solitary toxic adenoma

Ultrasound - Fine Needle Aspiration

Question 14

How are thyroid nodules investigated?

Answer 14

Thyroid function test for TSH

Ultrasound-guided fine needle aspiration for biopsy

Question 15

What classification systems are used to describe thyroid nodules viewed by

a) FNA
b) Ultrasound?

Answer 15

a) FNA - Thy 1 to 5

b) Ultrasound - U1 to U5

Question 16

What else can ultrasound scanning pick up?

Answer 16

Lymphadenopathy

Question 17

What are the two surgical options for solitary thyroid nodules?

Answer 17

Lobectomy

Total thyroidectomy

Question 18

When is lobectomy advised?

Answer 18

Low risk group:

Aged < 50, tumour < 4cm

Question 19

When is total thyroidectomy advised?

Answer 19

High risk patients:

Age > 50, tumour > 4cm, TSH low

Question 20

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

Answer 20

TNM staging

Question 21

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

Answer 21

Lower range of normal

You don’t want thyroid to be too metabolically active

Question 22

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

Answer 22

Thyroglobulin

Question 23

Diagnosis of follicular thyroid carcinoma depends on what?

Answer 23

Invasion of thyroid capsule

Question 24

How does follicular thyroid carcinoma spread?

Answer 24

By blood

Question 25

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

Answer 25

**minimally invasive**

Question 26

What percentage of women are on thyroxine for autoimmune hypothyroidism?

Answer 26

**5%**

Question 27

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

Answer 27

**Thyroid lymphoma**

Question 28

Thyroid lymphomas have an (insidious / rapid) onset.

Answer 28

**rapid onset**

Question 29

How are thyroid lymphomas treated?

Answer 29

**Steroids** Then chemo/radiotherapy

Question 30

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

Answer 30

**calcitonin**

Question 31

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

Answer 31

**Calcitonin**

Question 32

What three conditions run together in an MEN2a mutation?

Answer 32

**MTC** **Phaeochromocytoma** **Hyperparathyroidism**

Question 33

In a multinodular goitre, how is thyroid function assessed?

Answer 33

**TSH**

Question 34

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

Answer 34

**CT scan**

Question 35

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

Answer 35

**Retrosternal pain** **Stridor** **Orthopnoea** Surgical removal