Thyroid Flashcards
how long after Follicular lesion of undetermined significance should be followed up
3 months with repeat FNA
what is the follow up for benign follow up on FNA
6-18 months with repeat U/S
FNA shows “suspicious for follicular neoplasm” what is the next step
thyroid lobectomy
Do complete thyroidectomy if comes back positive for cancer
FNA shows “suspicious for malignancy”
near total thyroidectomy
When should you do a total thyroidectomy in PTC?
tumor greater than 4 cm bilateral nodules regional or metastatic disease personal hx of head/neck radiation first degree relative w/PTC
when should you do a thyroid lobectomy in PTC?
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
when to do a lymph node dissection with PTC? (central neck level VI and/or ipsilateral neck compartments II, III, IV)
all patients w/biopsy proven nodal dz
prophylactic central neck dissection for PTC should be done when?
high risk patients (large, bilateral, radiation)
even if no clinically positive nodes
what does unilateral RLN injury cause?
hoarseness
in patient with PTC, who gets RAI?
tumor > 4 cm
gross local invasion
selected patients w/tumor 1-4 cm and high risk features
what are high risk features of PTC
age > 45 years certain histologic types extra thyroid extension lymph-vascular invasion known metastatic dz
when is RAI done for PTC?
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
what is the follow up for PTC?
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
where does FTC tend to spread to?
hematogenously to bone, lung, liver
how to treat small (<1 cm ), unilateral, w/limited invasion FTC?
lobectomy
how would you treat FTC that is > 1 cm, multicentric, capsular and vascular invasion, or distant mets?
total thyroidectomy with RAI and life one TSH suppression
where does medullary thyroid cancer come from
parafollicular C cells
how does sporadic MTC present?
firm, palpable, unilateral nodule w/ or w/o involved cervical lymph nodes
how does hereditary MTC present?
bilateral, multifocal, w/dx on the basis of genetic or biochemical screening
should all patients with MTC undergo genetic testing?
yes
what is the photo-oncogene associated with MEN 2A and 2B?
RET
what important tumor markers are obtained with MTC?
calcitonin and CEA
correlate w/extent of disease
when should you do a total thyroidectomy alone for MTC?
MEN 2 patients who have thyroid nodules < 5 mm and calcitonin <40 pg/ml
what is the surgical treatment for MTC?
total thyroidectomy w/central neck compartment (level VI) lymph node dissection
+
additional dissection of ipsilateral lateral compartment nodes in patients w/palpable primary tumors
how is residual MTC treated?
surgery
is RAI used in MTC?
no
is adjuvant chemo or radiation used for MTC?
no
what tyrosine kinase inhibitors targeting the RET receptor have demonstrated improvement in progression survival?
Vandetanib
Cabozantinib
How do Vandetanib and Cabozantinib work?
inhibit tyrosine kinase inhibitor targeting the RET receptor
if a patient has a non-recurrent laryngeal nerve on the right what anatomic variation are they likely to have?
a retroesophageal subclavian artery
is a non recurrent laryngeal nerve more common on the left or right?
right
a direct laryngeal nerve on the right is d/t??
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
what is the origin of Hurthle cell carcinoma
follicular cells
what are some characteristics of hurtle cell carcinoma?
less common
occur in older people
more likely to mets than PTC or FTC
most do not take up RAI
what is the treatment for Hurthle Cell Carcinoma
total thyroidectomy
if lymph node involved do central lymph node dissection and modified neck dissection
what are the treatments for thyroid storm?
PTU or methimazole
steroids
