Assessment of a thyroid mass Flashcards

1
Q

History

A
  1. Symptoms of hyperthyroid
  2. Symptoms of hypothyroid
  3. Dysphonia, dysphagia, dyspnea
  4. Details of growth of mass
  5. Prior head/neck irradiation
  6. Recent infections etc
  7. Family history medullary thyroid cancer, other thyroid cancer, MEN, Cowdens
  8. PMHx, social, occupational, medications, allergies…
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2
Q

Examination

A
  1. Complete thyroid examination
  2. Hyper/hypothyroid
  3. Listen for dysphonia, dyspnea
  4. Evidence of other malignancy
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3
Q

Investigations

A
  1. TSH
  2. T4
  3. RAIU if hyperthyroid (TSH suppressed)
  4. Autoantibodies
  5. Serum calcium, PTH, calcitonin (FHx medullary ca)
  6. USS
  7. FNA >1cm
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4
Q

USS features which may suggest Ca

A
  1. Microcalcifications
  2. Absence of vascular halo
  3. Irregular margins
  4. Taller than wide shape
  5. Hypoechoic
  6. Increased vascularity
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5
Q

Bathesda criteria and management

A
  1. Non diagnostic->repeat FNA
  2. Benign->clinical F/U
  3. Atypia of undetermined significance or follicular lesion of undetermined significance->repeat FNA
  4. Follicular neoplasm or suspicious for follicular neoplasm->Surgical lobectomy
  5. Suspicious for malignancy->near total thyroidectomy or surgical lobectomy
  6. Malignancy-> near-total thyroidectomy
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6
Q

Surgical management algorithm

A

Includes

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