clinical thyroid disease 3 Flashcards
what are physiological causes of a goitre?
puberty and pregnancy
what are autoimmune causes of a goitre?
Graves’ disease
Hashimoto’s disease
what are infections of the thyroid that can cause a goitre?
Acute (de Quervain’s )
Chronic fibrotic (Reidel’s)
what are other causes of a goitre?
Iodine deficiency (endemic goitre)
Dyshormogenesis
Goitrogens
what are types of goitre?
Multinodular Goitre
Diffuse goitre
Colloid
Simple
Cysts
Tumours
Adenomas
Carcinoma
Lymphoma
Miscellaneous
Sarcoidosis, Tuberculosis
when do solitary thyroid nodules have a risk of malignancy?
Child
Adults less than 30 or over 60 years
Previous head and neck irradiation
Pain, cervical lymphadenopathy
does large dominant nodule of MNG need investigation?
yes
5% chance of malignancy
what investigations are done for a solitary thyroid nodule?
Thyroid function test
(solitary toxic nodule)
Ultrasound: useful in differentiating benign vs malignant
Fine needle aspiration (FNA)
Thy1: Inadequate
Thy 2: Benign to Thy 5: Cancer
what is the incidence of thyroid cancer?
what is papillary thyroid cancer?
Commonest
Multifocal, local spread to lymph nodes
Good prognosis
what is follicular thyroid cancer?
Usually single lesion
Metastases to lung/bone
Good prognosis if resectable
how is thyroid cancer managed?
Prognosis poorer
Age <16 or > 55, Tumour size, Spread outside thyroid capsule and metastases, TNM stage
Near Total Thyroidectomy
High dose radioiodine (Ablative)
Long term suppressive doses of thyroxine
Follow-up
Thyroglobulin
Whole body iodine scanning (following 2-4 weeks of thyroxine withdrawal or recombinant TSH injections)
Dynamic Risk Stratification (Tg and Neck Ultrasound)
following biopsy of metastatic follicular thyroid carcinoma what is the treatment plan?
following a thyroidectomy what would the radiation plan consist of?
