Head and Neck/ENT Flashcards
What is a goitre and what are the different types?
A swelling of the neck resulting from enlargement of the thyroid gland. This can be:
- Diffuse
- Nodular
What causes a diffuse goitre?
- Iodine deficiency
- Congenital
- Acute thyroiditis (de Quervains)
- Pregnancy
- Puberty
- Autoimmune (Graves, Hashimotos)
What is a multinodular goitre?
Most common thyroid gland disorder involving multiple neck lumps. May be retrosternal or substernal
Patients usually euthyroid but may become hyperthyroid (toxic) - rare to have malignancy or hypothyroidism
What is Plummer’s disease?
Hyperthyroidism with a single toxic nodule
What is a fibrotic goitre?
aka. Riedel´s thyroiditis (RT)
A rare inflammatory disease of the thyroid gland, causing compression and fibrosis of adjacent tissues
What are the causes of a single thyroid nodule?
- Cyst
- Adenoma (hyperthyroid/toxic won’t go away after a course of antithyroid drugs)
- Malignancy (10%)
- Discrete nodule as part of MNG
What investigations should be done for a neck lump?
BLOODS: T3/T4/TSH, thyroid autoantibodies if suspecting Graves/Hashimotos, virology, mantoux test
IMAGING: USS (looks at consistency), CXR with thoracic inlet (may show malignancy), radionuclide scan (hot/cold), CT (defines mass in relation to anatomical neighbours)
OTHER: FNA biopsy and cytology
What is the significance of hot/warm/cold nodules on radionuclide scan?
Refers to the uptake of the dye on scan
HOT - produce excess thyroid hormone, rarely malignant, likely adenoma
WARM - normal thyroid function
COLD - nonfunctional tissue, more likely to be malignant
How should impalpable nodules that show up on US be managed?
<1cm, no past history of thyroid cancer/radiation or family history of medullary cancer - OBSERVATION
Otherwise do USS guided FNA for biopsy and cytology
How should non-malignant thyroid enlargement with normal thyroid function be managed (incl symptoms of compression)?
No treatment needed unless breathing difficult or clinical concern.
Repeat US and TSH if malignant/compression suspected
If compressive symptoms - surgery, radioactive iodine ablation or percutaneous thermal ablation
What are the main types of thyroid cancer?
- Papillary (60%)
- Follicular(25%)
- Medullary (5%)
- Lymphoma (5%)
- Anaplastic
What are the features of papillary cancer?
- Younger patients
- Spreads to lungs via jugulo-digastric nodes
- Differentiated (cancer cells function like thyroid cells)
What are the features of follicular cancer?
- Middle aged patients
- Spreads early via blood to bone and lungs
- Differentiated (cancer cells function like thyroid cells)
What are the features of medullary cancer?
- May be sporadic or part of MEN syndrome
- May produce calcitonin which can be used as a tumour marker
- No response to iodine
- Should perform phaeochromocytoma screen pre-op
What are the features of lymphoma thyroid cancer?
- May present with stridor/dysphagia
- Assess tissue for MALT origin (better prognosis)
How is thyroid cancer managed initially?
Total thyroidectomy
Node excision
Radioactive iodine to ablate residual cells
MUST BE RENDERED EUTHYROID PRE-OP BUT STOP 10 DAYS BEFORE SURGERY
What can be given for differentiated cancer after radioactive iodine?
Lenvatinib and sorafenib (as long as they haven’t had a tyrosine kinase inhibitor before)
What are the complications of thyroid surgery?
- Recurrent laryngeal nerve palsy
- Haemorrhage
- Hypoparathyoidism (check calcium)
- Thyroid dysfunction incl storm
What are the most common neck lumps?
<3 weeks - self-limiting infection
Intradermal - sebaceous cyst or lipoma
What lumps are common in the midline?
<20yo patient - dermoid cyst or thyroglossal cyst
> 20yo - thyroid isthmus mass, chondroma (if bony hard)
What is a thyroglossal cyst, and what symptoms does it produce?
A fluid-filled space resulting from incomplete closure of the thyroids migration path.
Lump will move up on tongue protrusion, situated below the hyoid.
What lumps are common in the submandibular triangle?
<20yo - self limiting lymphadenopathy
> 20yo - exclude malignant lymphadenopathy (firm, non tender). May be TB, salivary stone, sialadenitis (infection of salivary glands), tumour
What defines the submandibular triangle?
The mental process, mandible and the line between the two angles of the mandible
What defines the anterior triangle?
Midline, anterior border of sternocleidomastoid muscle and line between the two angles of the mandible