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Endocrine > management of thyroid nodules > Flashcards

management of thyroid nodules Flashcards

1
Q

are solitary thyroid nodules usually malignant or benign?

A

95% benign

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2
Q

what are benign solitary thyroid nodules usually?

A
  • cysts
  • colloid nodules
  • benign follicular adenoma
  • hyperplastic nodule
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3
Q

what is the most common cause for a malignant solitary thyroid nodule?

A
  • papillary thyroid carcinoma (80%)
  • follicular thyroid carcinoma (10%)
  • medullary thyroid carcinoma (3%)
  • lymphoma (<5%)
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4
Q

what are indications to the nodule being in the thyroid?

A

-if it moves on swallowing

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5
Q

if a solitary thyroid nodule is painful what may this suggest?

A

-pain is an uncommon feature and is usually cause by intra thyroidal bleed into a cyst

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6
Q

what investigations should be done if a solitary nodule in the thyroid is found?

A
  • TSH levels

- USS FNA

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7
Q

what does Thy2 on FNA indicate?

A

benign

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8
Q

what does Thy2 on FNA indicate?

A

benign

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9
Q

what does Thy3 on FNA indicate?

A

its atypical

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10
Q

what does Thy4 on FNA indicate?

A

probably malignant

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11
Q

what does Thy5 on FNA indicate?

A

malignant

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12
Q

what does U2 on USS of a solitary thyroid nodule indicate?

A

benign

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13
Q

what does U2 on USS of a solitary thyroid nodule indicate?

A

benign

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13
Q

what does U2 on USS of a solitary thyroid nodule indicate?

A

benign

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14
Q

what does U3 on USS of a solitary thyroid nodule indicate?

A

atypical

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15
Q

what does U4 on USS of a solitary thyroid nodule indicate?

A

probably malignant

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16
Q

what does U5 on USS of a solitary thyroid nodule indicate?

A

malignant

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17
Q

what would treatment be if someone was a high risk group and had differentiated thyroid cancer? (DTC)

A

total thyroidectomy

consider radio-active iodine

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18
Q

what would treatment be if someone was a low risk group and had differentiated thyroid cancer? (DTC)

A

thyroid lobectomy

19
Q

what age would be considered low/high risk?

A

low risk <50

high risk> 50

20
Q

what tumour size would be considered low/high risk?

A

low<4 cms

high> 4cms

21
Q

what is the TNM classification for a tumour size 2cm of less?

A

T1

22
Q

what is the TNM classification for a tumour size >2 cm but 4 cm or less and limited to the thyroid?

A

T2

23
Q

what is the TNM classification for a tumour size >2 cm but 4 cm or less and limited to the thyroid?

A

T2

24
Q

what is the TNM classification for a tumour >4cms but limited to the thyroid or with minimal extrathyroidal extension (e.g. to stenothyroid muscle or perithyroid soft tissues)?

A

T3

25
Q

What is the TNM classification for moderately advanced disease; tumour of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, oesophagus, or recurrent laryngeal nerve?

A

T4a

26
Q

what is the TNM classification for very advanced disease; tumour invades prevertebral fascia or encases carotid artery or mediastinal vessels?

A

T4b

27
Q

what is the TNM classification for very advanced disease; tumour invades prevertebral fascia or encases carotid artery or mediastinal vessels?

A

T4b

28
Q

what is the TNM classification for no regional lymph node metastasis?

A

N0

29
Q

what is the TNM classification for regional lymph node metastasis?

A

N1

30
Q

what is the TNM classification for regional lymph node metastasis?

A

N1

31
Q

what is the TNM classification for metastases to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)?

A

N1a

32
Q

what is the TNM classification for metastases to unilateral, bilateral, or contralateral cervical (levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (level VII)?

A

N1b

33
Q

what is the TNM classification for no distant metastases found?

A

M0

34
Q

what is the TNM classification for distant metastasis present?

A

M1

35
Q

how may follicular thyroid carcinoma spread?

A

haematogenous spread

36
Q

what is the most common type of follicular thyroid cancer?

A

minimally invasive follicular thyroid cancer

37
Q

how is minimally invasive follicular thyroid cancer treated?

A

-usually with a thyroid lobectomy

if significant vascular invasion then consider a total thyroidectomy

38
Q

what disease is thyroid lymphoma associated with?

A

auto immune hypothyroidism (hashimotos)

39
Q

how does thyroid lymphoma usually present?

A

-rapid onset of mass in thyroid usually in females aged 70-80

40
Q

how is a thyroid lymphoma diagnosed?

A

-core biopsy for histological diagnosis

41
Q

how is thyroid lymphoma treated?

A

Chemo (R-CHOP)

DXT or steroids

42
Q

what does medullary thyroid carcinoma secrete?

A

calcitonin

43
Q

what are types of medullary thyroid carcinoma?

A
  • sporadic MTC
  • familial non MEN
  • femilial MEN (MEN2a)
44
Q

what should be done if a patient is found to have multinodular goitre?

A
  • assess function
  • assess structure
  • check TSH
  • CT scan
45
Q

what is the treatment for multinodular goitre?

A
  • most can leave
  • RAI (radioactive iodine if sign of hyperthyroid)
  • surgery if structural problem
46
Q

who with a retrosternal goitre should be offered surgery?

A
  • Lifestyle interfering symptoms
  • Possibility of cancer
  • Significant tracheal compression (?<7 mm) if symptomatic
  • Tracheal Flow Loops if other respiratory potential causes of orthopnoea/breathing difficulties
  • Audible Stridor

Endocrine (53 decks)

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