management of thyroid nodules Flashcards
are solitary thyroid nodules usually malignant or benign?
95% benign
what are benign solitary thyroid nodules usually?
- cysts
- colloid nodules
- benign follicular adenoma
- hyperplastic nodule
what is the most common cause for a malignant solitary thyroid nodule?
- papillary thyroid carcinoma (80%)
- follicular thyroid carcinoma (10%)
- medullary thyroid carcinoma (3%)
- lymphoma (<5%)
what are indications to the nodule being in the thyroid?
-if it moves on swallowing
if a solitary thyroid nodule is painful what may this suggest?
-pain is an uncommon feature and is usually cause by intra thyroidal bleed into a cyst
what investigations should be done if a solitary nodule in the thyroid is found?
- TSH levels
- USS FNA
what does Thy2 on FNA indicate?
benign
what does Thy2 on FNA indicate?
benign
what does Thy3 on FNA indicate?
its atypical
what does Thy4 on FNA indicate?
probably malignant
what does Thy5 on FNA indicate?
malignant
what does U2 on USS of a solitary thyroid nodule indicate?
benign
what does U2 on USS of a solitary thyroid nodule indicate?
benign
what does U2 on USS of a solitary thyroid nodule indicate?
benign
what does U3 on USS of a solitary thyroid nodule indicate?
atypical
what does U4 on USS of a solitary thyroid nodule indicate?
probably malignant
what does U5 on USS of a solitary thyroid nodule indicate?
malignant
what would treatment be if someone was a high risk group and had differentiated thyroid cancer? (DTC)
total thyroidectomy
consider radio-active iodine
what would treatment be if someone was a low risk group and had differentiated thyroid cancer? (DTC)
thyroid lobectomy
what age would be considered low/high risk?
low risk <50
high risk> 50
what tumour size would be considered low/high risk?
low<4 cms
high> 4cms
what is the TNM classification for a tumour size 2cm of less?
T1
what is the TNM classification for a tumour size >2 cm but 4 cm or less and limited to the thyroid?
T2
what is the TNM classification for a tumour size >2 cm but 4 cm or less and limited to the thyroid?
T2
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)?
T3
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?
T4a
what is the TNM classification for very advanced disease; tumour invades prevertebral fascia or encases carotid artery or mediastinal vessels?
T4b
what is the TNM classification for very advanced disease; tumour invades prevertebral fascia or encases carotid artery or mediastinal vessels?
T4b
what is the TNM classification for no regional lymph node metastasis?
N0
what is the TNM classification for regional lymph node metastasis?
N1
what is the TNM classification for regional lymph node metastasis?
N1
what is the TNM classification for metastases to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)?
N1a
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)?
N1b
what is the TNM classification for no distant metastases found?
M0
what is the TNM classification for distant metastasis present?
M1
how may follicular thyroid carcinoma spread?
haematogenous spread
what is the most common type of follicular thyroid cancer?
minimally invasive follicular thyroid cancer
how is minimally invasive follicular thyroid cancer treated?
-usually with a thyroid lobectomy
if significant vascular invasion then consider a total thyroidectomy
what disease is thyroid lymphoma associated with?
auto immune hypothyroidism (hashimotos)
how does thyroid lymphoma usually present?
-rapid onset of mass in thyroid usually in females aged 70-80
how is a thyroid lymphoma diagnosed?
-core biopsy for histological diagnosis
how is thyroid lymphoma treated?
Chemo (R-CHOP)
DXT or steroids
what does medullary thyroid carcinoma secrete?
calcitonin
what are types of medullary thyroid carcinoma?
- sporadic MTC
- familial non MEN
- femilial MEN (MEN2a)
what should be done if a patient is found to have multinodular goitre?
- assess function
- assess structure
- check TSH
- CT scan
what is the treatment for multinodular goitre?
- most can leave
- RAI (radioactive iodine if sign of hyperthyroid)
- surgery if structural problem
who with a retrosternal goitre should be offered surgery?
- 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
