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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
Q

ELND NOT DONE WHEN CALCITONIN

A

400

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26
Q

2 m Postop ct neck liver chest if calcitonin >

A

150

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27
Q

Drugs mtc

A

Vandetanib
Cabozatenib
Ret+- selpercatenib, pralsetinib

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28
Q

Anaplastic

A

Pet scan done

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29
Q

All are tested in ATC

A

• RET
• ALK
• NTRK
• dMMR
Msi
Braf
Tumor burden

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30
Q

Neoadjuvant thyca

A

Vandetanib
Lenvatenib
Cabozatinib

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31
Q

Adjuct Ct thy

A

Done in all ebrt imrt
Paclitaxel carbo
docetaxel doxo
Cisplatin
Doxorubicin
Imatinib also

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32
Q

Dose of Rai

A

30-50
50-100 in r1

33
Q

In mets rai

34
Q

Max dose of rai in lung mets in 48 hrs

35
Q

Tnm dtc

A

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
Q

N0a

37
Q

Atc staging

A

4a-1-3a
B-1-3a n1, t3b t4
C m1

38
Q

Thyroid named by

39
Q

Nodule maligannt rate

40
Q

High risk thy ca

A

Age>70, <14
H and N rad- 33-37% risk
Pet +
Fho
Men apc gardner cowden

41
Q

Rate of PET positive lesions associated with
malignancy?

42
Q

From what rad dose there is increased risk of
malignancy

43
Q

Ptc
Medulloblastoma
Hepatoblastoma
Syndrome

44
Q

Thyroid ca
Cushing
Cardiac myxoma

A

Carneys complex

45
Q

Most common trigger point mutation thyca

A

Braf v600e 40-50%

46
Q

Completenes of resection involved in ehich scoring system for dtc

A

MACIS SCORE

47
Q

Node postivity at diagnosis

A

38% ptc
4% ftc
6% hcc

48
Q

Tsh levels in diff risk

A

Low risk - 0.5-2
Intermediate-0.1-0.5
High - <0.1

49
Q

Usg guided ethanol ablation for nodal disease thy

A

Ptc and mtc in poor ds

50
Q

Which drug converts RAI-R to sensitive

A

Selumetanib- MEK1 and2 inhibitor

51
Q

Mc stage of ftc and ptc

52
Q

Mc cause of death in Atc

A

Distant mets lungs and bone> both> local complications >
50% mets at dx
40% extrathy exte

53
Q

Mtc most comon area

A

Upper area

54
Q

Fnac washout in mtc

A

Calcitonin
Chromogranin
Cea and absence of TG

55
Q

Pet scan useful in

A

Anaplastic>

56
Q

Localised mtc scan?

A

No scan useful
As calcitonin low

57
Q

Pet useful in mtc when calcitonin

58
Q

Mc stage of thyroid lymphoma

59
Q

M/c lymphoma in thy

60
Q

I131 scan dose

A

1-3 mci after 3-6 wks

61
Q

Pretherapy scan rai tsh dose

62
Q

Recurence scan for mtc

A

Dotage 68 gallium pet

63
Q

©5 and 10 yr survival 92% and 37% when
calcitonin doubling time is

64
Q

High risk dtc

A

Macroscopic ete
R1
Distant mets
Tg out of proprtion to whats seen on post treatment scan

65
Q

Intermediate risk
dtc

A

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
Q

Poorly diff tc criteria?

A

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
Q

Site of fusion of UBB and median thyroid process

A

Tubercle of zuckerkandl

68
Q

Most common mutations in atc

A

P53
Ctnnb1
Pik3

69
Q

Mitochondrial dna alternation thy ca

A

Hurthke cell ca

70
Q

Primary pigmented nodular adrenocortical disease leading to cushings asso with

71
Q

When is empirical RAI

A

Stimulated Tg >10
Or rapid increase or anti tg ab

72
Q

Atc microscopy

A

Necrosis
Spindle cell
Giant cell

73
Q

Bethesda 3 with niftp risk

A

10-30%
Without 6-8%
Otheriwse 10-15

74
Q

Fz in pap ca when

A

When fna is susp of pap ca and not defintite

75
Q

Selpercatinib

A

Mrc and atc

76
Q

Tirads

A

Margins
Echogenic foci
Echogenicity-hypoechoic more signi
Composition
Shape

77
Q

Fnac acc to tirads

A

3- fna if >2.5cm
4- 1.5
5-1 cm

78
Q

Adequate smear

79
Q

Niftp

A

Noninvasive follicular thyroid neoplasm with papillary nuclear features

Crash (20 decks)

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