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Thyroid Flashcards

1
Q

Thyroid exam 6 in neck

A

2 masses: Tongue protrusion & swallow + Cervical LNs

2 vascular: thyroid bruit and carotid pulse(Berrys sign)

2 respi: tracheal deviation and retrosternal extension

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2
Q

6 eyes of thyroid exam

A

2 mvmt: opthalmoplegia and lid lag
4 lid retraction, chemosis, proptosis, exophthalmos

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3
Q

6 arm steps of thyroid exam

A

Myopathy
Hyporeflexia
Tremors
Pulse
Palms
Nails

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4
Q

Treatment options for multinodular goitre

A
  1. Observation: Sx,PE,TFT and US
  2. Levothyroxine
  3. Ablation
  4. RAI
  5. Thyroidectomy
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5
Q

Marker for medullary thyroid cancer surveillance

A

Calcitonin

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6
Q

Types of thyroid cancer with good RAI uptake

A

Papillary and follicular

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7
Q

High risk features of thyroid nodules

A
  1. Solid
  2. Hypoechoic
  3. Microcalcifications
  4. Absence of halo
  5. Irregular margins
  6. Taller than wide
  7. Increased vascularity
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8
Q

TIRADS level where biopsy is recommended

A

4 and above

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9
Q

Difference between total and modified radical neck dissection

A

Sparing of one or all of SCM, IJV and CN XI

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10
Q

Boundaries of anterior neck

A

Hyoid bone, eternal notch, 2 SCMs?

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11
Q

Cutoff on FNAC score for requiring surgery and cannot offer follow up as treatment option

A

Bethesda 4

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12
Q

What is important to test in Medullary Thyroid cancer

A

For underlying MEN syndrome(Multiple Endocrine Neoplasia)

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13
Q

Sx of thyroid cancer

A
  1. Neck swelling
  2. LOA, LOW, Fever
  3. Compressive Sx( Esp in anaplastic)
    - Dyspnea
    - Dysphagia
    - Dysarthria
    - SVCO/ Pemberton
  4. Sx of Horner’s syndrome
  5. Sx of metastasis
  6. Sx of Hyperthyroidism(uncommon)
  7. Diarrhea and facial flushing: Paraneoplastic syndrome of MTC
  8. B- symptoms of Fever, LOW, night sweats in Thyroid lymphoma
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14
Q

Signs of thyroid cancer

A
  1. Midline thyroid nodule/mass
    - Solitary more common in papillary and follicular
    - Diffuse mass more common in medullary and anaplastic
    - Nodular, hard with irregular edges
  2. Cervical Lnopathy
  3. Berry’s sign: Carotid pulse masked by malignant infiltration
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15
Q

RFs of papillary thyroid cancer

A
  • Radiation exposure
  • Polyposis syndromes eg Gardners/FAP
  • Cowden syndrome
    Tends to mets to LNs
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16
Q

RFs of follicular thyroid ca

A
  • Radiation exposure
  • Cowden syndrome
17
Q

RFs of Medullary thyroic cancer

A
  • MEN 2A or 2B-> Almost 100% incidence(Prophylactic thyroidectomy in some countries)
  • Sporadic
  • FHx of calcium problems
18
Q

RFs for anaplastic thyroid cancer

A
  • Long standing goiter
  • Previous differentiated thyroid Ca
19
Q

Thyroid cancer risk stratification systems

A
  • TI RADs for malignancy risk on US
  • Bethesda classification for FNA specimen results
    Bethesda 1 is nondiagnostic NOT benign
    Bethesda 4 requires diagnostic hemithyroidectomy as FNAC cannot identify capsular/vascular invasion
  • AJCC for staging
  • ATA for selecting nodules for FNAC based on US
20
Q

High risk features on ultrasound for thyroid cancer

A
  1. Heterogenous with solid hypoechoic nodules
  2. Irregular margins
  3. Taller than wide
  4. Micro calcifications
  5. Hypervascularity
  6. Extrathyroidal extension
21
Q

T staging of thyroid cancer

A

T1: Tumor <1cm
T2: 1-2cm
T3a: 2-4cm
T3b: Extrathyroidal invasion only into strap muscles
T4a: Invasion into subcut soft tissue, larynx, trachea, esophagus or RLN
T4b: Invasion into prevertebral fascia, encasing carotid artery or mediastinal vessels

22
Q

Indications for total thyroidectomy for thyroid cancer

A
  • Tumor >4cm
  • FHx of thyroid ca
  • Medullary or anaplastic thyroid cancer
  • RAI required
23
Q

Thyroid cancers amenable to RAI for metastasis

A

PTC and FTC

24
Q

Precautions for RAI mx of thyroid Ca

A

avoid children, elderly, no unprotected sex, no sharing toilet unless double flush, avoid childbearing for 6-12 months

25
Q

Cx of thyroidectomy

A
  • Vocal cord palsy: Bilateral RLN injury can lead to stridor and respiratory distress
  • SLN injury affecting cricothyroid and voice
  • Postoperative hypocalcemia due to ischemia of the parathyroids
  • Neck hematoma
  • Tracheal injury and necrosis
    Rarer Cx
  • Tracheomalacia
  • Horner’s syndrome
  • Chyle leak
  • Esophageal injury: Heralded by neck subcutaneous emphysema
26
Q
A

GS (11 decks)

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