Neck Lumps Flashcards
important neck lumps are usually found where in the neck?
anterior triangle and midline
what can cause swelling in midline?
thyroid problem
dermoid cyst
thyroglossal cyst
what is a thyroglossal cyst?
remnants of thyroid cells left in thyroglassal duct as the thryroid descends during development
what is a branchial cyst?
swelling caused by remnant of 2nd branchial cleft in the neck
smooth swelling at anterior border of sternocleidomastoid
usually present in young adults
what is the most common parotid swelling?
pleomorphic adenoma
which nerves can be affected in a parotid swelling?
trigeminal nerve facial nerve (most common)
how can you tell if a swelling is thyroid related?
it moves up and down on swallowing (as its invested in pre-tracheal fascia)
how common are malignant thyroid lumps?
5% of women have thyroid lumps
5% of those are malignant
important questions to ask about a thyroid lump?
family history
fosset symptoms (pain, swallowing problems?)
previous history of neck radiation
examination in thyroid lump?
lymph node involvement (indicates papillary) hoarse voice (indicates recurrent laryngeal nerve involvement)
investigations in thyroid lump?
always do TSH levels
if TSH is suppressed (hyperthyroid) then do an isotope scan as risk of solitary toxic adenoma
always do US
if suspicious do US guided FNA
when is surgery indicated for thyroid lump?
//
what surgery is done?
whole thyroid removed in high risk
lobectomy done in low risk
high risk vs low risk thyroid tumours?
high risk = patient >50 and tumour >4cm
low risk = patient <50 and tumour <4cm?
causes of hyperthyroid?
graves disease (antobody against TSH - trab antibody) toxic nodules (singular or toxic multinodular goitre)
how is graves disease managed?
carbimazole or propriothiouracil (anti-thyroid drugs)
risks of carbimazole?
agranulocytosis (always do FBC urgently if they get a sore throat)
can cause hypothyroid in foetus in pregnant women should therefore use propriothiouracil in pregnancy
definitive treatment of thyrotoxicosis?
radioactive iodine
surgical removal of thyroid
complications of thyroidectomy?
damage to recurrent laryngeal nerve
damage/accidental removal of parathyroids (results in hypercalcaemia etc)
lifelong need for thyroxine
chance of bleeding/haematoma in neck which can compress airway
most thyroid cancers are whcih type?
papillary
tumour marker in thyroid?
thyroglobulin
used in papillary and follicular thyroid cells
what is medullary thyroid cancer?
cancer of parafollicular cells so causes increased calcitonin which can be used as a tumour marker
can be caused my MEN1 and MEN2
features which indicate a thyroid lump is malignanct?
firm nodule fixed to adjacent structures
symptoms of compression
abnormal cervical lymph nodes
irregular nodule with calcification
Thy classification system of thyroid lumps?
thy 1 = non-diagnostic 2 = non-neoplastic 3a = possible neoplasm (atypical features) 3f = follicular neoplasm 4 = suspicious of malignancy 5 = malignant
how does thy classification influence next steps?
thy 1 and 2 = US +/- FNA 3a = repeat US and FNA 3f = diagnostic hemithyroidectomy 4 = diagnostic hemithyroidectomy 5 = usually surgery
U classification system?
U1 = normal U2 = benign U3 = intermediate U4 = suspicious U5 = malignant only do FNA in U3-5
