Hypothyroidism

Question 1

Are most thyroid nodules are benign or cancerous?

Answer 1

Benign ~70%

Question 2

what are the most common types of noncancerous thyroid nodules?

how does it show up on a

Answer 2

benign adenoma

Question 3

what is the most common cause of multiple nodules

Answer 3

Hashimoto’s

Question 4

4 types of thyroid CA

who is at greatest risk?

Answer 4

Papillary: most common, most curable
Follicular: similar to papillary
Medullary (↑calcitonin levels, 60-70% cure rate)
Anaplastic (lethal form)

(<30 & >60 y.o. greatest risk)

Question 5

Risk for thyroid CA

Answer 5

Radiation exposure during childhood

Rapid growth of a nodule

hoarseness, vocal cord paralysis, dysphagia

FHx of thyroid CA or multiple endocrine neoplasia syndrome

Question 6

what PE exams would you perform on a thyroid nodule?

Answer 6

Gland: size, consistency, number
Solitary, hard, irregular and fixed = malignant

Lymph nodes: same side

Question 7

What are the guidelines for thyroid biopsy

Answer 7

Biopsy nodules > 1-1.5cm

↑risk hx: biopsy any thyroid nodule > 5 mm in diameter w/ suspicious features

Enlarged cervical lymph nodes

Question 8

What may be included in a thyroid nodule workup?

Answer 8

TSH
US
Biopsy
RAIU

Question 9

What are thyroid CA features?

Answer 9

Microcalcifications
hypoechoic
infiltrative margins
↑vascularity

Question 10

What are biopsy indications

Answer 10

Biopsy nodules > 1-1.5cm

↑risk hx: biopsy any thyroid nodule > 5 mm in diameter w/ suspicious features

Enlarged cervical lymph nodes

Question 11

What TSH value indicates RAIU should be performed?

Answer 11

low TSH

Question 12

what do the following RAIU results mean?

Answer 12

Hot = More likely to be autonomous → Rarely CA

Warm = Taking up iodine

Cold = Does not take up iodine

Question 13

Tx: After bx…

Answer 13

CA: Thyroidectomy

Benign: Monitor at least annually w/ US and TSH testing

Symptomatic: Consider thyroidectomy