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Endocrinology > Solitary Thyroid Nodule > Flashcards

Solitary Thyroid Nodule Flashcards

1
Q

What percentage of thyroid nodules are malignant?

A

5% (1/20)

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2
Q

What percentage of women get a thyroid nodule?

A

5% (1/20)

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3
Q

What is differentiated thyroid cancer (DTC)?

A

Cancer of thyroid epithelium which is divided into:
Papillary thyroid carcinoma
Follicular thyroid carcinoma

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4
Q

What are the 5 types of malignant thyroid cancer?

A

Papillary thyroid carcinoma

Follicular thyroid carcinoma

Medullary thyroid carcinoma

Lymphoma

Anaplastic

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5
Q

What thyroid cancer spreads

  1. through lymphatics?
  2. through blood?
A
  1. Papillary

2. Follicular

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6
Q

What do medullary thyroid carcinoma secrete?

A

Calcitonin

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7
Q

What genetic syndrome are medullary thyroid carcinoma associated with?

A

MEN2

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8
Q

What do differentiated thyroid carcinoma (DTC) do?

A

Take up iodine and secrete thyroglobulin which can be used as a tumour marker

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9
Q

What is anaplastic thyroid carcinoma?

A

Rare, poorly differentiated but highly aggressive thyroid carcinoma

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10
Q

What presentation would make you consider a thyroid lymphoma?

A

Rapid onset mass in a 70-80 year old female with previous Hashimoto’s thyroiitis

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11
Q

What neck mass

  • moves on swallowing?
  • moves on tongue protusion?
A
  1. Thyroid mass

2. Thyroglossal cyst

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12
Q

What investigations would you do in a patient with a thyroid mass?

A

TFTs (if showing primary hyperthyroidism, request iodine uptake scan)

Ultrasound guided fine needle aspiration (USS-FNA)

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13
Q

What does an ultrasound guided fine needle aspiration (USS-FNA) test show?

A

US provides picture of the nodule itself

FNA gives cytology of the nodule

Together, these build up a picture of malignancy risl

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14
Q

What are the FNA result classifications and what do they correlate to?

A

Thy1 - just blood, inadequate information. repeat

Thy2 - benign

Thy3 - atypical

Thy4 - probably malignant

Thy5 - malignant

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15
Q

What are the US result classifications and what do they correlate to?

A

U2 - not worrying (may not even do FNA)

U3 - more worrying (33% malignant)

U4/U5 - very malignant

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16
Q

What are the limitations of FNA? How is this overcome?

A

Doesn’t show if capsular invasion (important for follicular carcinoma classification and essential for lymphoma diagnosis)

Core biopsy

17
Q

What thyroid carcinoma can be diagnosed with USS-FNA and how?

A

Medullary

Presence of calcitonin/amyloid

18
Q

What are 1. papillary and 2. follicular thyroid carcinoma differentiated into?

A

Papillary

  • low risk (<50, <4cm)
  • high risk (>50, >4cm)

Medullary

  • minimally invasive (capsular invasion only)
  • widely invasive (invasion of extrathyroid tissue or metastasis)
19
Q

How are low and high risk papillary thyroid carcinoma treated?

A

Low risk - lobectomy

High risk- thyroidectomy

20
Q

How are minimally and widely invasive follicular carcinoma treated?

A

Minimally invasive - Lobectomy

Widely invasive - thyroidectomy

21
Q

How is thyroid lymphoma managed?

A

Chemotherapy

Steroids if acutely unwell

22
Q

What is the biggest killer after treatment for thyroid cancer?

A

Hypocalcaemia

23
Q

What follow-up scan is done 3-6 months after treatment and what does it involve?

A

Whole Body Iodine Scan

Radioactive iodine tablet (I-131)/rhTSH injection adminstered to patient

A few days later they return for a scan

Any remaning cancerous tissue would take up the iodine and show on the scan

24
Q

Is rhTSH injection or I-131 tablet preferred in whole body iodine scan preparation?

Why?

A

rhTSH is preferred as it isn’t TSH dependent as doesn’t require the patient to be in the hypothyroid state

25
Q

If a whole body iodine scan came back positive, what would be done?

A

Thyroid remnant ablation

Destruction of thyroid tissue with high dose radioactive iodine which destroys remaining cancerous tissue.

26
Q

What are some disadvantages of thyroid remnant ablation?

A

Takes 2 days

Has severe contact precautions

27
Q

What is involved in regular follow up post-thyroid cancer?

A

Measuring TSH (want to keep low)

Measuring tumour markers (calcitonin/thyroglobulin)

Endocrinology (10 decks)

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