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Rosalynn's ABSITE > Thyroid > Flashcards

Thyroid Flashcards

1
Q

how long after Follicular lesion of undetermined significance should be followed up

A

3 months with repeat FNA

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2
Q

what is the follow up for benign follow up on FNA

A

6-18 months with repeat U/S

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3
Q

FNA shows “suspicious for follicular neoplasm” what is the next step

A

thyroid lobectomy

Do complete thyroidectomy if comes back positive for cancer

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4
Q

FNA shows “suspicious for malignancy”

A

near total thyroidectomy

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5
Q

When should you do a total thyroidectomy in PTC?

A 
tumor greater than 4 cm
bilateral nodules
regional or metastatic disease
personal hx of head/neck radiation
first degree relative w/PTC
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6
Q

when should you do a thyroid lobectomy in PTC?

A

low risk pts with <1cm tumor
intrathyroid
univocal tumors w/o evidence of regional/metastatic dz
patients w/1-4 cm tumor can be considered for lobectomy or total thyroidectomy

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7
Q

when to do a lymph node dissection with PTC? (central neck level VI and/or ipsilateral neck compartments II, III, IV)

A

all patients w/biopsy proven nodal dz

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8
Q

prophylactic central neck dissection for PTC should be done when?

A

high risk patients (large, bilateral, radiation)

even if no clinically positive nodes

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9
Q

what does unilateral RLN injury cause?

A

hoarseness

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10
Q

in patient with PTC, who gets RAI?

A

tumor > 4 cm
gross local invasion
selected patients w/tumor 1-4 cm and high risk features

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11
Q

what are high risk features of PTC

A 
age > 45 years 
certain histologic types
extra thyroid extension
lymph-vascular invasion
known metastatic dz
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12
Q

when is RAI done for PTC?

A

2-4 weeks after total thyroidectomy once patient is hypothyroid (TSH > 30 mU/ml on no replacement of T4)
can be repeated 6-12 months if residual disease

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13
Q

what is the follow up for PTC?

A

serum thyroglobulin levels every 6-12 months

periodic neck U/S in patients that got anything less than a total thyroidectomy or did not get RAI

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14
Q

where does FTC tend to spread to?

A

hematogenously to bone, lung, liver

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15
Q

how to treat small (<1 cm ), unilateral, w/limited invasion FTC?

A

lobectomy

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16
Q

how would you treat FTC that is > 1 cm, multicentric, capsular and vascular invasion, or distant mets?

A

total thyroidectomy with RAI and life one TSH suppression

17
Q

where does medullary thyroid cancer come from

A

parafollicular C cells

18
Q

how does sporadic MTC present?

A

firm, palpable, unilateral nodule w/ or w/o involved cervical lymph nodes

19
Q

how does hereditary MTC present?

A

bilateral, multifocal, w/dx on the basis of genetic or biochemical screening

20
Q

should all patients with MTC undergo genetic testing?

A

yes

21
Q

what is the photo-oncogene associated with MEN 2A and 2B?

A

RET

22
Q

what important tumor markers are obtained with MTC?

A

calcitonin and CEA

correlate w/extent of disease

23
Q

when should you do a total thyroidectomy alone for MTC?

A

MEN 2 patients who have thyroid nodules < 5 mm and calcitonin <40 pg/ml

24
Q

what is the surgical treatment for MTC?

A

total thyroidectomy w/central neck compartment (level VI) lymph node dissection

+

additional dissection of ipsilateral lateral compartment nodes in patients w/palpable primary tumors

25
Q

how is residual MTC treated?

A

surgery

26
Q

is RAI used in MTC?

A

no

27
Q

is adjuvant chemo or radiation used for MTC?

A

no

28
Q

what tyrosine kinase inhibitors targeting the RET receptor have demonstrated improvement in progression survival?

A

Vandetanib

Cabozantinib

29
Q

How do Vandetanib and Cabozantinib work?

A

inhibit tyrosine kinase inhibitor targeting the RET receptor

30
Q

if a patient has a non-recurrent laryngeal nerve on the right what anatomic variation are they likely to have?

A

a retroesophageal subclavian artery

31
Q

is a non recurrent laryngeal nerve more common on the left or right?

A

right

32
Q

a direct laryngeal nerve on the right is d/t??

A

result of arteria lusoria vascular abnormality where the innominate artery is absent and right common carotid and subclavian arise directly from the arch – the subclavian artery takes a retroesophageal course

33
Q

what is the origin of Hurthle cell carcinoma

A

follicular cells

34
Q

what are some characteristics of hurtle cell carcinoma?

A

less common
occur in older people
more likely to mets than PTC or FTC
most do not take up RAI

35
Q

what is the treatment for Hurthle Cell Carcinoma

A

total thyroidectomy

if lymph node involved do central lymph node dissection and modified neck dissection

36
Q

what are the treatments for thyroid storm?

A

PTU or methimazole

steroids

Rosalynn's ABSITE (33 decks)

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