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Thyroid Flashcards

1
Q

Least involved level in thyroid ca

A

Va

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2
Q

RLN which arch

A

6 th

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3
Q

Rt non rec ln

A

1%

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4
Q

Features suggestive of malignancy thyroid

A

Taller than wide
Micro calcification
Rim calcificat
Irregular margins

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5
Q

Cect done when in thyroid ca

A

Local Advanced ca or with cord paresis

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6
Q

Indications for total
thyroidectomy or lobectomy, if all

A

..No prior radiation exposure
• No distant metastases
• No lateral cervical lymph node
metastases
D
• No extrathyroidal extension
Tumor 1-4 cm in diameter

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7
Q

]Indications for total
thyroidectomy (any present):

A

• Known distant metastases
• Extrathyroidal extension
• Tumor >4 cm in diameter
• Lateral cervical lymph node
metastases or gross central
neck lymph node metastases
• Poorly differentiated
• Consider for prior radiation
exposure (category 2B)
Consider for bilateral nodularity

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8
Q

After lobectomy completion thyroidectomy plus ND

A

Any of the following:
• Tumor >4 cm
• Gross positive resection
margins
• Gross extra-thyroidal extension
• Confirmed nodal metastasis
• Confirmed contralateral disease
• Vascular invasion
• Poorly differentiated

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9
Q

After lobectomy surveillance

A

All of the following:
• Negative resection margins
• No contralateral lesion
• Tumor <1 cm in diameter
• No suspicious lymph node
or
• NIFTP
Any of- lymphovasc or multiple micro either completion or surveilance

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10
Q

Completion thyroidectomy not done in

A

Central node <5 nodes none more than 2 mm

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11
Q

RAI INDICATION

A

Gross ETE
Tr> 4 cm
Postop unstimulated Tg >10 ng
Bulky or >5 positive lymph nodes
Known or suspected distant mets at presentation

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12
Q

RAI not recommended

A

If all present
Classic papillary thyroid carcinoma (PTC)
• Largest primary tumor <2 cm
• Intrathyroidal
• Unifocal or multifocal (all foci $1 cm)
• No detectable anti-Tg antibodies
• Postoperative unstimulated g <1 ng/mL
• Negative postoperative ultrasound, if done°

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13
Q

High risk pathology dtc

A

Tall cell
Insular
Diffuse sclerosing
Mucinous
Pd
Hobnail
Columnar

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14
Q

Dtc cut off of tg no more inv

A

<2

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15
Q

Systemic therapy for dtc

A

Lenvatenib

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16
Q

NTRK GENE +

A

Larotrectinib entrectinib

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17
Q

Ret postive thy CA meds

A

Selperactinib
Pralsetinib

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18
Q

High tumor mutational burden thy CA mab

A

Pembrolizumab

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19
Q

• Minimally invasive FTC is

A

Encapsulated
Microscopic capsular invasion

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20
Q

Ftc lobectomy when

A

Less than 4 vesels encapsulated angioinvasive and minimally invasive

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21
Q

RAi ftc

A

RAl recommended (if any preseni):
• Gross extrathyroidal extension
• Primary tumor >4 cm
• Extensive vascular invasiond
• Postoperative unstimulated Tg > 10 ng/LI,n
• Bulky or >5 positive lymph nodes

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22
Q

Rai ftc not recommended

A

RAI not typically recommended (if all present):
• Largest primary tumor <2 cm
• Intrathyroidal
• No vascular invasion
• Clinical NO
• No detectable anti-Tg antibodies
• Postoperative unstimulated g <1 ng/mL!
• Negative postoperative ultrasound, if donem

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23
Q

Imaging ct etc in mtc when calcitonin > than

A

400

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24
Q

Men2 prophylactic level 2-5 dissection done when

A

2b age 1 -tt
2-5 if tr more than 0.5 cm
2a age 5-tt
If cn +
Or tr>1 cm

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25
ELND NOT DONE WHEN CALCITONIN
400
26
2 m Postop ct neck liver chest if calcitonin >
150
27
Drugs mtc
Vandetanib Cabozatenib Ret+- selpercatenib, pralsetinib
28
Anaplastic
Pet scan done
29
All are tested in ATC
• RET • ALK • NTRK • dMMR Msi Braf Tumor burden
30
Neoadjuvant thyca
Vandetanib Lenvatenib Cabozatinib
31
Adjuct Ct thy
Done in all ebrt imrt Paclitaxel carbo docetaxel doxo Cisplatin Doxorubicin Imatinib also
32
Dose of Rai
30-50 50-100 in r1
33
In mets rai
100- 200
34
Max dose of rai in lung mets in 48 hrs
80
35
Tnm dtc
T1 a-<1cm b- 1-2 T2- 2-4 T3-a- >4 limit to thy b- ete - strap muscles T4a- s/c larynx trach esoph rln 4b- prevert fasc Carotid Mediastinal vessels
36
N0a
Bening ln
37
Atc staging
4a-1-3a B-1-3a n1, t3b t4 C m1
38
Thyroid named by
Warton
39
Nodule maligannt rate
10-15%
40
High risk thy ca
Age>70, <14 H and N rad- 33-37% risk Pet + Fho Men apc gardner cowden
41
Rate of PET positive lesions associated with malignancy?
30-50%
42
From what rad dose there is increased risk of malignancy
0.1 Gy
43
Ptc Medulloblastoma Hepatoblastoma Syndrome
Fap
44
Thyroid ca Cushing Cardiac myxoma
Carneys complex
45
Most common trigger point mutation thyca
Braf v600e 40-50%
46
Completenes of resection involved in ehich scoring system for dtc
MACIS SCORE
47
Node postivity at diagnosis
38% ptc 4% ftc 6% hcc
48
Tsh levels in diff risk
Low risk - 0.5-2 Intermediate-0.1-0.5 High - <0.1
49
Usg guided ethanol ablation for nodal disease thy
Ptc and mtc in poor ds
50
Which drug converts RAI-R to sensitive
Selumetanib- MEK1 and2 inhibitor
51
Mc stage of ftc and ptc
Stage 2
52
Mc cause of death in Atc
Distant mets lungs and bone> both> local complications > 50% mets at dx 40% extrathy exte
53
Mtc most comon area
Upper area
54
Fnac washout in mtc
Calcitonin Chromogranin Cea and absence of TG
55
Pet scan useful in
Anaplastic>
56
Localised mtc scan?
No scan useful As calcitonin low
57
Pet useful in mtc when calcitonin
>1000
58
Mc stage of thyroid lymphoma
1E
59
M/c lymphoma in thy
Dlbcl
60
I131 scan dose
1-3 mci after 3-6 wks
61
Pretherapy scan rai tsh dose
>30
62
Recurence scan for mtc
Dotage 68 gallium pet
63
©5 and 10 yr survival 92% and 37% when calcitonin doubling time is
6-24 m
64
High risk dtc
Macroscopic ete R1 Distant mets Tg out of proprtion to whats seen on post treatment scan
65
Intermediate risk dtc
Microscopic tumour invasion of perithyroidal soft tissue • Cervical modal metastases or RAl uptake outside the thyroid bed on first post-treatment scan • Tumour with aggressive histology or vascular invasion
66
Poorly diff tc criteria?
Turin criteria 1. Presence of a trabecular/insular/solid growth pattern. • 2. Absence of the classical PTC nuclear features. • 3. Presence of convoluted nuclei, mitotic activity
67
Site of fusion of UBB and median thyroid process
Tubercle of zuckerkandl
68
Most common mutations in atc
P53 Ctnnb1 Pik3
69
Mitochondrial dna alternation thy ca
Hurthke cell ca
70
Primary pigmented nodular adrenocortical disease leading to cushings asso with
Carneys
71
When is empirical RAI
Stimulated Tg >10 Or rapid increase or anti tg ab
72
Atc microscopy
Necrosis Spindle cell Giant cell
73
Bethesda 3 with niftp risk
10-30% Without 6-8% Otheriwse 10-15
74
Fz in pap ca when
When fna is susp of pap ca and not defintite
75
Selpercatinib
Mrc and atc
76
Tirads
Margins Echogenic foci Echogenicity-hypoechoic more signi Composition Shape
77
Fnac acc to tirads
3- fna if >2.5cm 4- 1.5 5-1 cm
78
Adequate smear
?
79
Niftp
Noninvasive follicular thyroid neoplasm with papillary nuclear features

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