Thyroid

Question 1

TIRADS USS findings

Answer 1

CESME
- Composition - solid
- Echogenicity - hypoechoic
- Shape - taller than wide
- Margin - irregular, extra thyroidal extension, lobulated
- Echogenic Foci - peripheral rim calcifications or punctate calcifications

Question 2

Bethesda

Answer 2

I - Non diagnostic - 1-4% risk malignancy
II - Benign - 0-3% risk malignancy

III - AUS / FLUS - 5-15% risk malignancy
- Atypia of undetermined significance
- Follicular lesion of undetermined significant

IV - Follicular neoplasm / suspicious for follicular neoplasm - 15-30% risk of malignancy

V - Susp for malignancy - mostly papillary ca - 60-75% malig
VI - Malignant - 97-99% risk of malig

Question 3

Bethesda Tx

Answer 3

Bethesda I - Non diagnostic - Repeat FNA with USS or consider core
Bethesda II - Benign - nil

Bethesda III - AUS/FLUS - close follow up / repeat vs lobectomy

Bethesda IV - Follicular - hemithyroidectomy diagnostic (vs total thyroid)

Bethesda V - Susp for Malig - hemi or total thyroidectomy, as per ca
Bethesda VI - Malignant - OT

Question 4

TIRADS

Answer 4

TR1 - Benign - 0 points - 0.3% malig No FNA

TR2 - Not susp - 2 points 1.5% malig No FNA

TR3 - Mildly susp - 3 points approx 5% malig
- 25mm biopsy
- 15mm fu

TR4 - Mod susp - 4-6 points approx 10% malig
- 15mm biopsy
- 10mm fu

TR5 - Highly susp - 7 or more - approx 35% malig
- 10mm biopsy
- 5mm fu

Surveillance FU - annual 5 years (skip years 2 and 4 if low risk) - look for 20% increase and 2mm in 2 dimensions, or 50% increase in volume.