Endocrine - Thyroid Masses Flashcards

1
Q

Presentations and treatment of Nontoxic Multinodular Goitre?

A

More common in females
Usually asymptomatic and euthyroid
- can get compressive symptoms
- can get sudden pain due to haemorrhage

Treatment:

  • usually manage conservatively
  • AVOID contrast or iodine substance (can enhance thyroid production = Jod Basedown Effect)
  • Radioactive iodine
  • Steroids if acute compression
  • surgery is highly effective
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2
Q

Presentations and treatment of Toxic Multinodular Goitre?

A

Often in elderly patients
Can present with goitre and subclinical hyperthyroidism
Can be precipitated by contrast

Scan: heterogenous uptake

Treatment:

  • antithyroid drugs if elderly
  • radioiodine
  • surgery for definitive treatment
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3
Q

What is a Toxic Thyroid Adenoma (Hyperfunctioning solitary nodule) usually due to? How is it treated?

A

Usually due to somatic activating mutation of TSH-R

Treat with radioiodine ablation

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4
Q

What are the ultrasound characteristics of a malignant thyroid nodule?

A
  • hypoechoic nodule, SOLID
  • Irregular margin and intranodular vascularity
  • “taller than wide” shape
  • egg shell calcification around nodule periphery
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5
Q

When do do FNA for thyroid nodule?

A

TSH: if suppressed then may be ‘HOT’ and should do Tc99m scan

Based on lesion size:
<1cm: repeat evaluation in 6-12 months
1-2cm: FNA if high risk features
>2cm: FNA

if volume increases by 30% of diameter by 10mm –> FNA!!

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6
Q

What mutations are associated with toxic adenoma?

A

TSH-R antibody

Gs protein

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7
Q

What mutations are associated with PAPILLARY THYROID CANCER

A
  • BRAF V600E (MEK kinase gene)
  • RET/PTC
  • TRK
  • RAS gives papillary follicular variant
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8
Q

What mutations are associated with FOLLICULAR THYROID CANCER?

A

RAS

MET

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9
Q

What mutations are associated with MEDULLARY THYROID CANCER?

A

RET in MEN2

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10
Q

What mutations are associated with ANAPLASTIC THYROID CANCER?

A

p53
p21/WAF
beta-catenin

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11
Q

What is the RAS pathway?

A

RET/PTC–>RAS–>BRAF–>MEK1/2–>ERK1/2

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12
Q

Poor prognostic features of thyroid cancer?

A

Age >40yrs
Tumour size >4cm
Local extension or distal metastases

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13
Q

Features suggestive of FOLLICULAR thyroid cancer:

A
  • previous neck irradiation
  • FHx of thyroid cancer
  • Rapid growth
  • Very firm or hard nodule
  • fixation ot adjacent structures
  • vocal cord paralysis
  • Distal metastases
  • regional lymphadenoapthy
  • PET incidentaloma
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14
Q

Histo of PAPILLARY thyroid cancer

A

Psammoma bodies
Cleaved nucleus with “Orphan Annie” appearance due to large nucleoli
Papillary structures

Tend to be slow growing

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15
Q

Histo of FOLLICULAR thyroid cancer

A

spreads haematogenously

Histo: microfollicular architecture

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16
Q

Histo for thyroid mass has psammoma bodies…what is the diagnosis?

A

Papillary thyroid cancer

17
Q

Histo for thyroid mass has microfollicular architecture…what is the diagnosis?

A

Follicular thyroid cancer

18
Q

Histo for thyroid mass has “Orphan Annie” large nucleoli with cleaved nucleus….what is the diagnosis?

A

Papillary thyroid cancer

19
Q

Treatment for thyroid cancer?

A

Total thyroidectomy
Remnant ablation with Iodine 131

If non-iodine avid recurrence and progressive:

  • VEGF inhibitors
  • BRAF inhibitors
20
Q

Management of thyroid cancer post thyroidectomy?

A

If >1cm OR follicular:

  • post op TSH stimulated remnant ablation with iodine 131
  • lifelong TSH suppression
  • regular surveillance scan and Tg levels

If <1cm without invasion/mets:

  • NO remnant ablation needed
  • NO TSH suppression needed
21
Q

What are the Systemic Therapies for FOLLICULAR thyroid cancer?

A

Rosiglitazone / Pioglitazone ONLY if PPARy expression

Multitargeted Kinase Inhibitors:

  • selemetinib
  • sorafenib
  • vandetanib
  • lenvatinib
  • vemurafenib

–> kinase inhibitors improve PFS, best results seen in lung metastases patients
BUT stabilises disease rather than halting progression

22
Q

What does Vemurafenib do?

A

Targets BRAF Val600glu

23
Q

How is Tg used as a biochemical marker post surgery for thyroid cancer?

A

Tg is dependent on thyroid volume
It is SENSITIVE and SPECIFIC for differentiated thyroid cancer

Used:

  • at 6 months post op to check completeness of surgery and as a prognostic marker
  • at >6 months to monitor efficacy
  • also need to check Anti-Tg antibodies to check validity