Feb5 M1-Thyroid Nodules

Question 1

thyroid cancer most common in who

Answer 1

women between 20 and 50 yrs of age

Question 2

when to workup thyroid nodules (ultrasound and biopsy) EXAM (2)

Answer 2

1. size ­­above 1.5 cm

2. size less than 1.5 cm but family history or been exposed to radiation

Question 3

thyroid nodule workup: what is done EXAM (3)

Answer 3

ultrasound, ultrasound guided biopsy, molecular testing eventually

Question 4

treatment of thyroid cancer EXAM (2)

Answer 4

1. surgery

2. consider radioactive iodine if aggressive mass

Question 5

2 things to be careful about in thyroid surgery

Answer 5

1. don’t hit recurrent laryngeal nerve

2. don’t remove parathyroid glands (will be fine with one of 4 though)

Question 6

epi charact of thryoid cancer that’s important

Answer 6

cancer with most rapidly increasing incidence rate

Question 7

ddx of thyroid mass and %

Answer 7

• benign (95%): adenoma or multinodular goitre

- malignant (5%)

Question 8

history and physical in thyroid nodule patient

Answer 8

family history, weight loss, trouble swallowing, hoarse voice, exposure to radiation

Question 9

most common benign thyroid tumor

Answer 9

adenoma

Question 10

most common malignant thyroid cancer and % of malignant thyroid cancers it represents EXAM

Answer 10

papillary thyroid CA. 80%.

Question 11

2nd most common thyroid malignant cancer and other name for it

Answer 11

follicular thyroid CA. Also clled Hurthle cell CA.

Question 12

3rd most common thyroid malignant cancer and associated with what

Answer 12

medullary thyroid carcinoma.

associated with MEN syndrome Type 2A and type 2B (multiple endocrine neoplasia)

Question 13

4th most common thyroid malignant cancer and characteristics

Answer 13

anaplastic carcinoma. very aggressive. cells go crazy, it’s a mush.

Question 14

other things than 4 first carcinomas on thyroid nodule ddx

Answer 14

lymphoma, metastasis

+TB as general internal med differential

Question 15

things that differentiate carcinoma from adenoma

Answer 15

CA has angioinvasion (vessels) + extracapsular spread (not enclosed in a capsule)

Question 16

prognoses of the diff thyroid CAs

Answer 16

papillary: good
follicular: good
medullary: sometimes good sometimes bad
anaplastic: very bad. no one survives

Question 17

marker of medullary carcinoma

Answer 17

calcitonin levels (from parafollicular or C cells)

Question 18

ultrasound cancer vs not cancer in thyroid

Answer 18

black=cancer
white=not cancer
grey=not sure

Question 19

problem with biopsies

Answer 19

20% are indeterminate (can’t know if it’s cancer)

Question 20

proportion of grey on US that turns out to be thyroid cancer

Answer 20

33%

Question 21

2 treatment options (2 methods) if couldn’t know if it’s thyroid cancer + how changed today

Answer 21

1. surgery just in case
2. US + biopsy every 6 months
   Now have molecular testing for genes

Question 22

most common and most aggressive mutation in thyroid cancer + its kind of thyroid cancer

Answer 22

BRAF. in papillary thyroid cancer

Question 23

treatment of thyroid CA with BRAF mutation (papillary)

Answer 23

surgery + radiation bc it’s aggressive (malignant)

Question 24

mutations found in more than 70% of thyroid CAs

Answer 24

BRAF and RAS point mutations

RET/PTC rearrangements