Assessment of a thyroid mass Flashcards
1
Q
History
A
- Symptoms of hyperthyroid
- Symptoms of hypothyroid
- Dysphonia, dysphagia, dyspnea
- Details of growth of mass
- Prior head/neck irradiation
- Recent infections etc
- Family history medullary thyroid cancer, other thyroid cancer, MEN, Cowdens
- PMHx, social, occupational, medications, allergies…
2
Q
Examination
A
- Complete thyroid examination
- Hyper/hypothyroid
- Listen for dysphonia, dyspnea
- Evidence of other malignancy
3
Q
Investigations
A
- TSH
- T4
- RAIU if hyperthyroid (TSH suppressed)
- Autoantibodies
- Serum calcium, PTH, calcitonin (FHx medullary ca)
- USS
- FNA >1cm
4
Q
USS features which may suggest Ca
A
- Microcalcifications
- Absence of vascular halo
- Irregular margins
- Taller than wide shape
- Hypoechoic
- Increased vascularity
5
Q
Bathesda criteria and management
A
- Non diagnostic->repeat FNA
- Benign->clinical F/U
- Atypia of undetermined significance or follicular lesion of undetermined significance->repeat FNA
- Follicular neoplasm or suspicious for follicular neoplasm->Surgical lobectomy
- Suspicious for malignancy->near total thyroidectomy or surgical lobectomy
- Malignancy-> near-total thyroidectomy
6
Q
Surgical management algorithm
A
Includes