4: Management of thyroid nodules Flashcards
What are the two main types of thyroid nodule?
Solitary thyroid nodule
Multinodular goitre
The vast majority of solitary thyroid nodules are ___.
benign
Who tends to develop thyroid nodules?
Women
What is the most common type of malignant thyroid nodule?
Papillary thyroid carcinoma
Papillary and ___ thyroid carcinomas are malignant epithelial tumours.
papillary and follicular
What is a malignant cancer of the parafollicular cells of the thyroid?
Medullary thyroid carcinoma
Which fascial layer contains the thyroid?
Pretracheal fascia
What happens to the thyroid when you swallow?
Moves up and down along with the larynx
Nodules should move up and down as well
Thyroid nodules are usually (painful / painless).
painless
When would a thyroid nodule be painful?
Usually bleeding into a cyst > expansion > nerve compression
What two questions must be asked on history of a thyroid lump?
Neck irradiation?
Family history of thyroid cancer?
helps differentiate between benign and malignant
What two signs must be checked for on examination of a thyroid lump?
Enlarged lymph nodes
papillary spreads via lymph, follicular haematogenously
Hoarseness
recurrent laryngeal nerve palsy - can be eroded by cancer
What are two important investigations for someone presenting with a neck lump?
TSH
usually normal, suppressed in hypothyroidism, solitary toxic adenoma
Ultrasound - Fine Needle Aspiration
How are thyroid nodules investigated?
Thyroid function test for TSH
Ultrasound-guided fine needle aspiration for biopsy
What classification systems are used to describe thyroid nodules viewed by
a) FNA
b) Ultrasound?
a) FNA - Thy 1 to 5
b) Ultrasound - U1 to U5
What else can ultrasound scanning pick up?
Lymphadenopathy
What are the two surgical options for solitary thyroid nodules?
Lobectomy
Total thyroidectomy
When is lobectomy advised?
Low risk group:
Aged < 50, tumour < 4cm
When is total thyroidectomy advised?
High risk patients:
Age > 50, tumour > 4cm, TSH low
What common staging system can be used to stage thyroid cancer?
TNM staging
Following treatment of a thyroid cancer, what is the ideal TSH level?
Lower range of normal
You don’t want thyroid to be too metabolically active
What is used as a marker for differentiated thyroid cancer activity after treatment?
Thyroglobulin
Diagnosis of follicular thyroid carcinoma depends on what?
Invasion of thyroid capsule
How does follicular thyroid carcinoma spread?
By blood
Most follicular thyroid carcinomas are (invasive / minimally invasive).
minimally invasive
What percentage of women are on thyroxine for autoimmune hypothyroidism?
5%
What type of thyroid nodule can occur in women as a conseqeuence of long term thyroxine use?
Thyroid lymphoma
Thyroid lymphomas have an (insidious / rapid) onset.
rapid onset
How are thyroid lymphomas treated?
Steroids
Then chemo/radiotherapy
Medullary thyroid carcinoma is a malignant cancer of the C cells which produce ___.
calcitonin
What is used as a tumour cell marker in medullary thyroid carcinoma?
Calcitonin
What three conditions run together in an MEN2a mutation?
MTC
Phaeochromocytoma
Hyperparathyroidism
In a multinodular goitre, how is thyroid function assessed?
TSH
What scan is used to assess which structures are being squashed by a multinodular goitre?
CT scan
If a multinodular goitre is compressing structures, what symptoms may be produced?
How is this treated?
Retrosternal pain
Stridor
Orthopnoea
Surgical removal
