Neck Lumps

Question 1

What are the two types of goitre + what is the most common cause of goitre?

Answer 1

Diffuse
Multinodular
Iodine deficiency

Question 2

What is the TSH and T3/T4 level in goitre?

Answer 2

High TSH

Normal T3/4

Question 3

What is multi-nodular goitre caused by?

Answer 3

Hyperplasia due to long term goitre

Question 4

What are the 2 risks of multi nodular goitre?

Answer 4

Hyperthyroidism

Malignancy

Question 5

Do a CT scan in MNG to check for what 2 things?

Answer 5

Retrosternal extension

Tracheal compression

Question 6

MNG may have what type of lesion?

Answer 6

Dominant nodule

Question 7

Name 5 tests for thyroid lumps.

Answer 7

US
TSH
FNA
Core biopsy
Laryngoscopy

Question 8

US scored from U2-U5 with 2 being … and 5 being …?

Answer 8

Benign

Malignant

Question 9

FNA scored from Thy2-Thy5 with 2 being … and 5 being …?

Answer 9

Benign

Malignant

Question 10

Follicular lesions are always scored … on the Thy score?

Answer 10

Thy 3

Question 11

Most common benign thyroid lump?

Answer 11

Follicular adenoma

Question 12

What is a follicular adenoma + solitary/multifocal + functional/non-functional?

Answer 12

Neoplastic thyroid follicles with collagen capsule
Solitary
Non-functional

Question 13

Name the the 2 mutations of the TSHR linked to follicular adenoma.

Answer 13

Ras

PIK3CA

Question 14

Thyroid cancer is associated with … and … and is more common in men/women?

Answer 14

Ionising radiation
Iodine deficiency
Women

Question 15

Name 5 AMES red flags of malignant thyroid disease.

Answer 15

Age < 20 or > 50
Increasing size
> 4 cm
History of radiation
Vocal nerve palsy

Question 16

Name 4 types of thyroid cancer + what cells they arise from + which is the most common?

Answer 16

Papillary, follicular (MOST COMMON)
Follicular, follicular
Medullary, parafollicular
Anaplastic, follicular

Question 17

Are papillary tumours solitary or multifocal + type of spread?

Answer 17

Multifocal

Lymph and haematogenous spread

Question 18

2 mutations associated with papillary thyroid tumours?

Answer 18

PET/PTC

BRAF

Question 19

Papillary thyroid tumours can be c…. and c…. and are seen with …. bodies?

Answer 19

Cystic
Calcified
Psammoma

Question 20

Name 2 causes of papillary thyroid tumours?

Answer 20

Ionising radiation

Hashimoto’s thyroiditis

Question 21

What is the prognosis for papillary thyroid tumours?

Answer 21

Good

Question 22

What is the treatment for thyroid tumours + non-surgical option if cancer persists?

Answer 22

Lobectomy or total thyroidectomy + radioioidine

Thyroid remnant ablation

Question 23

Are follicular carcinomas solitary or multifocal + key mutation + type of spread?

Answer 23

Solitary
PAX8-PPAR
Haematogenous

Question 24

What is follicular carcinoma associated with?

Answer 24

Iodine deficiency

Question 25

Prognosis of follicular carcinomas depends on?

Answer 25

Degree of capsular invasion

Question 26

What do medullary carcinomas secrete?

Answer 26

Calcitonin

Question 27

Name 2 paraneoplastic syndromes associated with medullary carcinoma + the hormones?

Answer 27

``` Diarrhoea = VIP Cushing's = ACTH ```

Question 28

Sporadic and familial medullary carcinoma are seen in ... people whereas ... cases are linked to ...?

Answer 28

Older | MEN 2

Question 29

Sporadic medullary carcinoma is usually ... and familial is ....?

Answer 29

Solitary | Bilateral/multicentric

Question 30

Name a type of cell + a deposition molecule associated with medullary carcinoma.

Answer 30

Spindle cell | Amyloid

Question 31

Anaplastic carcinoma is seen in what age group with what history?

Answer 31

Older | Thyroid cancer

Question 32

What type of care is needed for anaplastic carcinoma + why?

Answer 32

Palliative | Poorly differentiated cancer so very aggressive

Question 33

What 2 tests are done post-thyroid surgery and what are they looking for?

Answer 33

Serum Ca = Ca < 2 mmol/l | Iodine body scan = cancer cells

Question 34

When does T4 and T3 need to be stopped before an iodine body scan?

Answer 34

``` T4 = 4 weeks T3 = 2 weeks ```