management of thyroid nodules

Question 1

what is the difference between a mass, a nodule and a lesion?

Answer 1

masses>4cm
nodules 1-4cm
lesions <1cm

Question 2

are small lesions clinically detectable?

Answer 2

No-radiologically detected

Question 3

what do follicular cells produce?

Answer 3

thyroglobulin

Question 4

what do parafollicular cells produce?

Answer 4

calcitonin

Question 5

what is the prevelance of thyroid nodules?

Answer 5

5% of females
1% of males

Question 6

do we test TSH?

Answer 6

yes

Question 7

is calcitonin blood test routinely done?

Answer 7

No (only if history or cytology is suggestive of MTC)

Question 8

do we test thyroglobulin, thyroglobulin antibody or PTH?

Answer 8

no

Question 9

how are thyroids graded?

Answer 9

U1 – Normal
U2 – Benign
U3 – Indeterminate / Equivocal
U4 – Suspicious
U5 – Malignant

Question 10

when would we use a radioisotope scan for imaging?

Answer 10

if TSH is supressed (<0.4 mlU/L)

Question 11

when is fine needle aspiration cytology used?

Answer 11

anything above U2

Question 12

what is the scoring system for thyroid nodules?

Answer 12

Thy1 / Thy1c – Insufficient or Insufficient cystic

Thy2 / Thy2c – Non-neoplastic or Cystic

Thy3a [25% cancer] – Neoplasm possible (nuclear Atypia)

Thy3f [31% cancer] – Neoplasm possible (Follicular or oncocytic neoplasms)

Thy4 [80% cancer] – Suspicious of malignancy (unsuitable for Thy3a,Thy3f or Thy5)

Thy5 [98% cancer] – Malignant (tumour type should be clearly stated if possible)

Question 13

what is the majority of thyroid cancers?

Answer 13

differentiated thyroid cancer (90%)
(papillary-80%)
(follicular-15%)
(hurthle-5%)

Question 14

what is the usual treatment for Thy4/5?

Answer 14

hemithyroidectomy or total thyroidectomy

Question 15

treatment for Thy3a or thy3f?

Answer 15

diagnostic hemithyroidectomy