The thyroid nodule

Question 1

DDx for a thyroid mass if it is solitary

Answer 1

• cyst
• adenoma - hot or cold
• thyroid cancer - carcinoma vs multiple
• multinodular -

Question 2

what investigations would you order for a thyroid nodule?

Answer 2

• TSH

- ultrasound

Question 3

what are the high risk features of a nodule on ultrasound?

Answer 3

• hypoechoic
• hypervascular-
• microcalcifications

Question 4

If suspect a nodule and TSH is normal then

Answer 4

• Biopsy!

Question 5

If suspect a nodule and TSH is suppressed then

Answer 5

• RAI to check if hot or cold

Question 6

If nodule is hot then

Answer 6

treat hyperthyroidism

Question 7

neoplastic possibilities for a thyroid nodule

Answer 7

• papillary thyroid carcinoma - PTC

- follicular adenoma

Question 8

aetiology of thyroid cancer

Answer 8

• external radiation
• family Hx
• high iodine intake,
• obesity, insulin resistance

Question 9

thyroid carcinomas can be classified as

Answer 9

• well-diff (PTC, FTC) - >90%
• Poor-diff
• anaplastic

Question 10

features of anaplastic thyroid carcinoma

Answer 10

• p53 mutation

- mean age 65

Question 11

MTC carcinoma - derived from

Answer 11

Parafollicular cells (secrete calcitonin and CEA)

Question 12

mutations in MTC cancer

Answer 12

• 80% sporadic
• 20%
  
  • germline RET
  • MEN2A,B,

Question 13

which diagnosis can you make on a FNA

Answer 13

• pTC

Question 14

Most aggressive carcinoma is

Answer 14

medullary! - CEA and calcitonin good markers

Question 15

What size does the nodule have to be in order to be biopsied?

Answer 15

> 1cm

Question 16

complications of thyroidectomy

Answer 16

• laryngeal nerve damage

- hypocalcemia