7. Goitre + Neck Lumps Flashcards
If someone presents with a neck lump, what are the reg flags you need to be worried about?
- Dysphagia
- Neck pain
- Hoarse voice
- History of radiation to neck
- Family history of thyroid cancer
What is dysphagia?
Swallowing difficulties
What is the main histological type of thyroid cancer?
Papillary carcinoma (70% of cases)
What treatment options are there for thyroid cancers?
- Surgery (total thyroidectomy or lobectomy)
- Post-operative radioactive iodine treatment (selected cases)
- Thyroid hormone suppression (to suppress TSH so that tumour growth isn’t stimulated)
What is a goitre?
Enlarged thyroid
If someone has a goitre, other than a thyroid disease, what do you need to be worried about?
That it could be compressing nearby structures, such as the trachea or oesophagus
How common are thyroid nodules?
- If palpating, you can find a nodule in 20% of the population
- If performing an ultrasound, you can find a nodule in up to 50% of the population.
- Up to 60% of normal thyroids have nodules when an autopsy is performed.
Why are more nodules found on ultrasound as opposed to palpation?
The nodules have to be a lot bigger (greater than 1 cm) for you to palpate them, compared to a scan, where they only have to be bigger than 2mm.
If you palpate a nodule in the thyroid, what other clinical signs do you need to take in to consideration to assess whether its cancerous?
- Age
- How long they’ve had the nodule
- Iodine Status
- Radiation Exposure
- Thyroid Status
- Presence of solitary nodule vs multi nodular
- Are there any pressure symptoms? (ie. is it pressing on other structures?)
What investigations can you do on someone with suspected thyroid cancer? Where is it done?
Fine needle aspiration.
Can be done blindly in the clinic, but its preferably done with ultrasound guidance
How are thyroid cancers graded?
Thy1-5
What is Thy1?
Thy1 is non-diagnostic, and is when there is just not enough cells to tell. This accounts for up to 20% of samples. For these individuals, you need to redo the needle aspiration for a better sample.
What is Thy2?
Thy2 is when it is clearly benign, where there are lots of cells that appear normal. This accounts for up to 70% of test results.
What is Thy3?
Thy3 is classed as indeterminate. There is a follicular lesion, which could either be an adenoma or carcinoma. It is hard to differentiate between them so it needs to be removed.
What is Thy4?
Thy4 is classed as a suspicion of malignancy. About 30% of these individuals will actually have a malignancy (ie. true positive). Individuals with this have to have the nodules surgically removed.
