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Endocrinology - Rachel Doohan Y5 > The Management of Thyroid Nodules > Flashcards

The Management of Thyroid Nodules Flashcards

1
Q

thyroid nodules are either

A
  • solitary thyroid nodule
  • multi nodular goitre
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2
Q

around how many solitary thyroid nodules are…

A

95% of all solitary thyroid nodules are benign

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3
Q

causes of benign solitary thyroid nodules

A
  • cyst
  • colloid nodules
  • benign follicular adenoma
  • hyperplastic nodule
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4
Q

what are the remaining solitary thyroid nodules

A

5% of solitary thyroid nodules are malignant

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5
Q

types of malignant thyroid carcinoma

A
  • papillary
  • follicular
  • medullary
  • anaplastic
  • other
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6
Q

what is the most common type of malignant thyroid carcinoma

A

papillary which accounts for 80%

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7
Q

what are papillary and follicular thyroid carcinomas classified as

A

differentiated thyroid carcinomas

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8
Q

before you start investigating what should you make sure

A

that whatever your feeling is actually attached to the thyroid i.e. it should move up on swelling as the thyroid is invested by the pre tracheal fascia

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9
Q

what is an uncommon feature of a solitary thyroid nodule

A

pain and if it is painful then is usually caused by bleeding into a thyroglossal duct cyst

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10
Q

6 key steps when any person presents to you with a thyroid nodule

A
  • 2 questions
  • 2 examinations
  • 2 investigations
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11
Q

2 questions you should ask

A
  • have you ever been exposed to radiation?
  • is there any family history of thyroid cancer?
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12
Q

2 examination findings

A
  • is there any associated lymphadenopathy
  • is there any associated hoarseness of voice
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13
Q

palpable lymph nodes along with a solitary thyroid nodule

A

is papillary cell carcinoma until proven otherwise as papillary cell carcinoma spreads lymphatically

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14
Q

if there is hoarseness of voice

A

suggests invasion into the recurrent laryngeal nerve and is probably caused by an aggressive type of thyroid carcinoma

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15
Q

2 investigations

A
  • TSH level
  • ultrasound guided fine needle aspirate (USFA)
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16
Q

benign thyroid nodules TSH level

A

usually have a low TSH and high T3 and T4 as they usually cantina functioning thyroid tissue

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17
Q

malignant thyroid nodules TSH level

A

usually have a normal TSH level excuse the nodule is non-functioning

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18
Q

ultrasound classifications

A

U1: normal (no nodule)
U2: benign
U3: indeterminate
U4: suspicious
U5: malignant

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19
Q

only what ultrasound classifications get a fine needle aspiration

A

U3-U5

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20
Q

fine needle aspiration classification

A

thy1: inadequate aspiration (redo it)
thy2: benign
thy3: atypical (all follicular lesions)
thy4: most likely malignant
thy5: malignant

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21
Q

thy 5 is diagnostic of

A

either papillary or medullary or anapaestic or lymphoma or metastatic tumour

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22
Q

management of differentiated thyroid cancers

A

first decide if the patient is low or high risk

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23
Q

low risk criteria for differentiated thyroid cancer

A

aged less than 50 and tumour is less than 4cm

24
Q

management of low risk differentiated thyroid cancers

A

lobectomy

25
Q

high risk criteria for thyroid cancer

A

agree greater than 50 and tumour is more than 4cm

26
Q

management of high risk thyroid cancer

A

subtotal/ total thyroidectomy

27
Q

post-surgery stratification for differentiated thyroid cancer using the

A

AMES SYSTEM

28
Q

AMES SYSTEM

A

age
metastases
extension of primary tumour
size of primary tumour

29
Q

in tayside the protocol for clearance of lymph nodes for differentiated thyroid cancer is as follows

A
  • for papillary carcinoma the central compartment is cleared and the lateral compartment is sampled (and cleared if its spread)
  • for follicular carcinoma the central compartment is cleared and the lateral compartment is left alone
30
Q

post-surgery management f differentiated thyroid carcinomas

A
  • start thyroxine treatment and monitor TSH levels surpassing them at the lower limit of normal
  • monitor thyroglobulin as the 2 tumour are derived from follicular cells so produce thyroglobulin so it can be used as a tumour marker, as post-surgery thyroglobulin levels should be negligible
31
Q

papillary carcinoma

A

most common type of thyroid cancer accounting for 80% and has the best prognosis

32
Q

papillary carcinoma is more common in

A

3x more common in females

33
Q

histology of papillary carcinoma

A

no capsule and nuclei appear empty (known as ORPHAN ANNIE EYE)

34
Q

papillary carcinomas are derived from

A

follicular cells and spread via the lymph nodes

35
Q

papillary carcinoma is more common in those with

A

RET AND BRAF MUTATIONS and if you’ve been exposed to radiation as a child

36
Q

papillary cell carcinoma secretes

A

thyroglobulin and takes up radio iodine

37
Q

follicular carcinoma accounts for

A

10% of thyroid carcinomas

38
Q

follicular carcinomas are most common in who

A

3x more common in females

39
Q

follicular carcinomas are derived from

A

follicular cells and spread haematogenously

40
Q

increased risk of follicular carcinoma in those with

A

RAS mutations

41
Q

histology of follicular carcinomas

A

surround by a capsule

42
Q

if the capsule is intact then by definition it is a

A

benign follicular adenoma

43
Q

if the capsule is not intact then by definition it is a

A

follicular carcinoma

44
Q

what can you not tell from fine needle aspiration which is relevant to follicular cell carcinoma

A

whether the capsule is intact or not so can only be seen when examined post-surgery

45
Q

follicular cell carcinoma is classified as

A

minimally invasive thyroid carcinoma or widely invasive

46
Q

follicular cell carincomas secrete

A

thyroglobulin and take up radioactive iodine

47
Q

medullary thyroid carcinoma accounts for

A

3% of all thyroid carcinomas and is more aggressive than the 2 differentiated types

48
Q

medially thyroid cancer is derived from

A

parafollicualr C cells so secreted calcitonin which can be used as a tumour marker

49
Q

on histology of medullary thyroid carcinomas

A

stroma is made of AMYLOID

50
Q

4 TYPES of medullary thyroid carcinoma

A
  1. sporadic MTC
  2. familial MTC
  3. MEN2a
  4. MEN2b
51
Q

familial thyroid carcinoma, MEN2a and MEN2b are all used by

A

defects on RET genes on chromosome 10

52
Q

MEN2a

A
  • MEDULALRY THYROID CARCINOMA
  • PHAEOCHROMOCYTOMA
  • HYPERPARATHYROIDISM
53
Q

IS MEN2A IS KNOWN ABOUT WHAT IS CARRIED OUT

A

a prophylactic thyroidectomy while young

54
Q

MEN2b

A
  • medullary thyroid carcinoma
  • pheochromocytoma
  • hyperparathyroidism
  • nueromas
55
Q

about MEN2b

A

probably never see in practise as they allude very young of aggressive medullary thyroid carcinoma

56
Q

anaplatic carcinomas known as

A

undifferentiated thyroid carcinomas

57
Q

anaplatic carcinomas mostly affects

A

the elderly and are deadly

Endocrinology - Rachel Doohan Y5 (28 decks)

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