OnlineMedEd: Endocrine - "Thyroid Nodules" Flashcards
What patient characteristic correlates with the highest risk of thyroid cancer?
Neck radiation
Look for the person who survived lymphoma and got radiation treatments.
List some other patient characteristics that correlate with increased risk of thyroid cancer.
- Advanced age or young age
- Personal or family history of cancer
- Hoarseness
LIst the nodule characteristics that increase risk of cancer.
- Firm
- Fixed
- Hard
- Non-tender
List the ultrasound characteristics that go with increased risk of cancer.
- Hypoechogenic
- > 2 cm
- Microcalcifications
- Irregular borders
The first step in evaluating a thyroid nodule is ______.
TSH
- Low TSH goes with low-risk of malignancy because the nodule is functioning.
- High or normal TSH goes with a high-risk because the nodule is definitely not functional.
After the TSH is discovered to be low, get a ______________.
radioactive iodine uptake scan (RAIU scan) to see if it is the nodule that is secreting the T3/T4
- Hyperfunctioning = not cancer, treat hyperthyroidism
- Hypofunctioning = maybe cancer, get an US and FNA.
After the TSH is discovered to be high or normal, get a _______________.
US
- > 1 cm: biopsy
- < 1 cm: repeat US in 6-12 months
Describe what you should do on FNA results.
- Cancer: resect
- Not cancer: repeat US in 6-12 months
- Indeterminate: repeat FNA until definitive
List the four types of thyroid cancer and some facts about each.
•Papillary:
- 85% of thyroid cancers
- orphan Annie nuclei
- resection
- great prognosis
•Follicular:
- 5%
- biopsy looks just like thyroid
- hematogenous spread
- because it is just thyroid, radioactive iodine can kill even metastatic disease
•Medullary:
- c-cells (that make calcitonin)
- RET oncogene
- MEN2B and MEN2A
• Anaplastic:
- elderly people
- locally invasive
- frequently fatal
