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Endocrine Week 3 2017/18 > 9: Differentiated thyroid cancer > Flashcards

9: Differentiated thyroid cancer Flashcards

1
Q

Rank the types of thyroid cancer from most common to least common.

A

Papillary (absolutely most common)

Follicular

Medullary (C cells)

Anaplastic (killer)

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2
Q

Papillary and follicular thyroid cancers are described as ___.

A

differentiated

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3
Q

Differentiated thyroid cancers secrete ___ and take up ___.

A

secrete thyroglobulin (used as a tumour marker)

take up iodine (so iodine can be used to both investigate and kill the cancer)

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4
Q

Which hormone drives papillary and follicular thyroid cancer?

A

TSH

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5
Q

Differentiated thyroid cancers have a (good / bad) prognosis.

A

good prognosis

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6
Q

Thyroid cancer is more common in (males / females).

A

females

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7
Q

Thyroid cancer is strongly associated with exposure to what?

A

Radiation

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8
Q

Thyroid cancer incidence increases following what type of accidents?

A

Nuclear incidents

e. g Chernobyl, Fukushima
www. theguardian.com/world/2014/mar/09/fukushima-children-debate-thyroid-cancer-japan-disaster-nuclear-radiation

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9
Q

How long does it take for thyroid cancer to develop following nuclear incidents?

A

4 years - several decades

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10
Q

What is found on thyroid examination in the majority of thyroid cancers?

A

Palpable nodules

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11
Q

Thyroid cancer is a chance finding following what procedure?

A

Thyroidectomy

for say hyperthyroidism secondary to Graves disease

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12
Q

What is the most common type of thyroid cancer?

A

Papillary

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13
Q

Papillary thyroid cancer spreads via which system?

A

Lymphatic system

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14
Q

Papillary thyroid cancer is associated with what type of thyroiditis?

A

Hashimoto’s thyroiditis

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15
Q

Follicular thyroid cancer tends to spread how?

A

Haematogenously

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16
Q

How are suspected thyroid cancers investigated?

A

Ultrasound-guided FNA

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17
Q

How is thyroid cancer initially treated?

A

Surgery

18
Q

What are the surgical options for treating thyroid cancer?

A

Lobectomy (including the isthmus)

Sub-total thyroidectomy

Total thyroidectomy

19
Q

Why isn’t lobectomy commonly carried out anymore?

A

Leaves half the thyroid intact, skewing thyroid function tests, drug doses etc.

20
Q

Depending on the risk calculated following surgery, what treatment is added on for thyroid cancer?

A

Thyroid remnant ablation (TRA)

using radioiodine

21
Q

Which risk stratification tool is used post-op in thyroid cancer?

A

AMES system

Age, Metastases, Extent of primary tumour, Size of primary tumour

22
Q

The AMES system divides post-op thyroid cancer patients into which two groups?

A

Low risk (cancer is/was confined to the thyroid)

High risk (spread outwith the thyroid)

23
Q

Which group of patients receive radioactive iodine treatment post-op?

A

High risk patients

24
Q

In which type of cancer would lymph node surgery be considered in addition to surgery and TRA?

A

Papillary

because it tends to spread lymphatically

25
Q

Why can patients become hypocalcaemic following thyroid surgery?

A

Removal of parathyroid glands

26
Q

Following thyroid surgery, what drug are patients discharged with?

A

Thyroxine tablets

Calcium / recombinant PTH if parathyroids removed

27
Q

What test is carried out 3-6 months post-op to detect remnants of thyroid cancer?

A

Whole body iodine scanning

to check for metabolically active cells, i.e cancer

28
Q

What needs to be elevated before a patient recieves a whole body iodine scan?

A

TSH

to stimulate the metabolism of the cancer cells so they show up on the scan

29
Q

How are a patient’s TSH levels raised prior to their whole body iodine scan?

A

Stop taking their thyroxine for 2-4 weeks (produces hypothyroid symptoms)

rhTSH injections (don’t need to stop thyroxine, but very expensive)

30
Q

If thyroid cancer is still active following surgery, what treatment is given to patients?

A

Thyroid remnant ablation

using radioactive iodine

31
Q

Patients undergoing thyroid remnant ablation need to have a (raised / suppressed) TSH and undergo treatment (at home / in isolation).

A

raised TSH

in isolation (as their necks are really radioactive)

32
Q

What protein is used as a tumour marker for differentiated thyroid cancer?

A

Thyroglobulin

as it is produced by papillary and follicular carcinomas

thyroxine precursor

33
Q

Following treatment for differentiated thyroid cancer, you want to keep a patient’s TSH (high / low).

A

low

remember that it drives the cancer

so high to investigate, low post-op

34
Q

What is an uncommon disease which can be caused by thyroid remnant ablation?

A

Acute myeloid leukaemia (AML)

patients must be informed of this (1 : 10000 chance)

35
Q

How often are thyroid cancer patients followed up in clinic post-treatment?

A

Every 2 months

36
Q

Following treatment for thyroid cancer, what are patients put on?

A

Thyroxine tablets

37
Q

How can you tell if thyroid cancer has recurred?

A

Raised thyroglobulin

Metastasis to other parts of the body

38
Q

If a patient has suspected recurrence of thyroid cancer, what test would you do?

A

Whole body iodine scan

again

39
Q

What is the recurrence rate of differentiated thyroid cancer?

A

30%

40
Q

Apart from whole body iodine scanning, what other imaging may be used to identify areas of active cancer i.e in metastatic disease?

A

PET scan

41
Q

What is the general timeline of investigation and treatment in a patient presenting with DTC?

A

Ultrasound-guided FNA

Surgery

Whole body iodine scan –> Thyroid remnant ablation

Thyroxine and regular follow-up

Endocrine Week 3 2017/18 (11 decks)

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