Diseases of the Thyroid and Parathyroid glands

Question 1

What is the work up for a thyroid nodule?

Answer 1

• H&P
• Laryngoscopy (visualize the cords)
• Labs (TSH, T4, serum Ca++)
• Ultrasound

Question 2

What features are more high risk for thyroid malignancy?

Answer 2

• Male
• Age: Younger than 30, or older than 60
• Positive family hx
• Radiation exposure as a child
• Elevated TSH/Hashimoto’s thyroiditis
• Rapid growth
• Pain
• Compressive symptoms
• Hoarseness
• Cervical lymph nodes

Question 3

Ultrasound features of thyroid nodule that are indications for FNA?

Answer 3

• > 1cm if high risk features
• Microcalcifications
• Irregular margins
• Solid rather than cystic
• Internal vascularity
• Multiple nodules
• Enlarged cervical lymph nodes on the same side of the neck

Question 4

True or false: with follicular lesions , I-123 scan “hot” lesions are likely malignant

Answer 4

False

Question 5

How do you follow up on a benign thyroid nodule?

Answer 5

serial ultrasounds every 6-12 months

Question 6

What is the differential diagnosis in thyroid tumors?

Answer 6

• Papillary, 70-85%
• Follicular, 15-20%
• Medullary, 3-10%
• Hurthle, 3-5%
• Anaplastic, <2%

Other: lymphoma, SCC, metastasis

Question 7

Which multiple endocrine neoplasm (MEN) tumor is associated with medullary thyroid carcinoma?

Answer 7

MEN IIa:

• medullary thyroid carcinoma of the thryoid
• pheochromocytoma
• parathyroid hyperplasia