EXAM #1: THYROID CANCER Flashcards
What is the difference between a tyroglossal duct cyst and a cervical cyst?
Midline= thyroglossal duct cyst Lateral= cervical cyst
Where does the superior thyroid artery come from?
External carotid artery
Where does the inferior thyroid artery come from?
Thyrocervical trunk
What is a potential complication of a tracheostomy that results in excessive bleeding?
Transsection of a “Thyroid ima artery” that runs along the anterior trachea
Where does the Inferior thyroid vein drain?
Brachiaocephalic
Where do the superior and middle thyroid veins drain?
Internal jugular vein
What nerve do you need to be especially conscious of when performing a thyroidectomy?
Recurrent laryngeal nerve of the vagus
*Most common is Injury to the external branch of the superior laryngeal nerve–not a big deal. Most dreaded is injury to the recurrent laryngeal bilaterally.
What does the recurrent laryngeal nerve innervate?
All intrinsic muscles of the larynx EXCEPT the cricothyroid muscle
Where does the recurrent laryngeal nerve lie?
tracheoesophageal groove
What is the differential diagnosis for a thyroid nodule?
1) Cyst
2) Thyroid adenoma
3) Infection/ thyroiditis
4) Developmental abnormality
5) Carcinoma
6) Thyroid lymphoma
*Note that most are NOT malignant
What is an important historical feature to ask patients about when taking a thyroid related history?
Radiation exposure
What is the most reliable and cost effective method for diagnosing thyroid nodules? When is this absolutely indicated?
FNA
*Note that this is indicated for any nodule greater than 1 cm; less than 1 cm is less clear
What information can you discern from a thyroid US?
1) Solid vs. cystic
2) Homogenous vs. heterogenous
If a radionuclear scan of the thyroid is performed, which is more likely to be malignant–hot or cold nodule?
Cold nodule
What are the differentiated thyroid cancers? How are these followed and treated?
1) Papillary
2) Follicular
3) Hurthle Cell
*Followed with thyroglobulin and treated with radioactive iodine
What is the c-cell cancer?
Medullary Thyroid Cacner
What is pathognomonic for papillary thyroid cancer?
Psammoma bodies
What is Follicular Thyroid Cancer?
Neoplastic proliferation of thyroid follicles that invades the capsule
How is follicular thyroid cancer spread?
Hematogenously
Where does follicular thyroid cancer commonly metastasize?
- Bone
- Lung
- Liver
- CNS
What is Hurtle Cell Cancer?
Variant of Follicular Thyroid Cancer
*Difficult to determine if benign or malignant via FNA
What is Medullary Thyroid Cancer?
Malignant neuroendocrine tumor of parafollocular C-cells
What are the markers for Medullary Thyroid Cancer?
Calcitonin
CEA
What do you need to screen for in patients with Medullary Thyroid Cancer?
1) Pheochromocytoma
2) Hyperparathyroidism
What syndromes are associated with Medullary Thyroid Cancer?
MEN 2A and 2B
Is medullary thyroid cancer response to radioactive iodine?
NO
What do you need to measure after surgery for medullary thyroid cancer?
Calcitonin
What are the clinical features of anaplastic thyroid cancer?
- Rapidly enlarging
- Painful
- Symptomatic
What is the primary treatment for anaplastic thyroid cancer?
Chemoradiation
What is Thyroid Lymphoma?
Rare lymphoma that develops from the thyroid gland
What is the treatment for thyroid lymphoma?
Chemoradiation
If a thyroid tumor is less than 1 cm in size, what surgical procedure should be performed?
Lobectomy
What stage are all anaplastic carcinomas considered?
Stage IV–worst prognosis
What are the best relative 5-year survival rates for the thyroid cancers?
1) Papillary
2) Follicular
3) Medullary
When is lymph node dissection warranted?
Grossly positive nodes on physical exam or imaging–no consensus otherwise
What are the post-surgical complications of a thyroidectomy?
1) Hematoma
2) Nerve injury
3) Hypocalcemia
What is Chovstek’s sign?
Tapping on the cheek causes spasm
What is Troussseau’s sign?
Carpopedal spasm with BP cuff
Should you give a patient thyroid hormone after thyroid surgery?
NO–send to an Endocrinologist
