Thyroid

Question 0

Patient gets low-dose radiation – risk of thyroid cancer? Type of thyroid cancer?

Is the same risk present for iodine ablation?

Answer 0

40% risk of papillary carcinoma

No risk with iodine ablation

Question 1

Risk factors for thyroid cancer?

Answer 1

#Radiation history
#Family history
#Changes in voice/airway (Horseness, dyspnea, dysphasia)
#Thyroid nodular pattern

Question 2

Patient presents with isolated 1 cm nodule on thyroid. Moves when patients swallows. Patient has history of neck radiation. Next step?

Answer 2

thyroidectomy – no additional evaluation

Question 3

Thyroid cancer associated with family history? Genetics? Is suspicious lesion, look for what lab value? If lab value confirmatory, when surgery?

Answer 3

Medullary thyroid cancer; ensemble dominant

Calcitonin; evaluate patients for MEN tumors (pheochromocytoma, adrenal hyperplasia, hyperparathyroidism) before surgery

Question 4

Risk of malignancy in solitary thyroid nodule?

Risk of malignancy in cyst over 4 cm?

Risk of malignancy in a dominant nodule in multinodular gland?

Answer 4

15%

15%

Less than 5% (unless previously the radiation)

Question 5

Patient presents with 1 cm thyroid nodule. No risk factors. Nodule is solitary, but not hard/fixed. Vocal cords move normally. Next step?

Answer 5

FNA lesion

Question 6

Management of thyroid cysts?

Answer 6

#Complete FNA
#If over 4 cm or recurs several times, removal to eliminate risk of malignancy

Question 7

Next step if FNA of thyroid nodule shows:

1. Colloid nodule
2. Papillary carcinoma
3. Medullary carcinoma
4. Psamoma bodies
5. Amyloid

Answer 7

1. Benign – Medical thyroid suppression. No surgery.
2. Thyroidectomy
3. Thyroidectomy
4. Marker for papillary cancer. Thyroidectomy.
5. Marker for medullary cancer. Thyroidectomy.

Question 8

Next step if FNA of thyroid nodule shows:

1. Undifferentiated cells
2. Hurthle cells
3. Follicular cells
4. Lymphocytic infiltrate

Answer 8

1. Indicates anaplastic cancer. Chemoradiation or salvage operation
2. Indicates adenoma or low-grade cancer. Lobectomy. Thyroidectomy if cancer present
3. Nondiagnostic. Lobectomy for diagnosis
4. Lymphoma or chronic lymphocytic thyroiditis. Flow cytometry to distinguish. Radiation if lymphoma; thyroid replacement if thyroiditis

Question 9

Risks of thyroid cancer surgery?

Answer 9

#Standard – bleeding, infection
#Nerve injury (recurrent laryngeal or superior laryngeal)
#Damage to parathyroid with resultant hypocalcemia

Question 10

Management for patient with papillary cancer?

Answer 10

1. If lesion is a 1 cm or less:
#if previous radiation exposure, total thyroidectomy
#Otherwise thyroid lobectomy and isthmusectomy

2. If tumor is larger than 1.5 cm – thyroidectomy

Question 11

Surgical management for follicular cancer?

Answer 11

#For microinvasive lesions under 4 cm, lobectomy and isthmusectomy
#If Microinvasive lesions greater than 4 cm, total thyroidectomy
#If clear follicular cell cancer greater than 1 cm, thyroidectomy

Question 12

Goal of surgery in undifferentiated thyroid cancer?

Answer 12

Prevent future respiratory compromise

Question 13

Prognostic scale for papillary thyroid cancer?

Answer 13

AGES

Age under 40 better
(Pathologic Grade
Extent of disease
Sizes of tumor

Variable 10-year survival (20% – 100% based on prognostic factors)

Question 14

Prognostic factors in follicular thyroid cancer?

Answer 14

AGES + vascular invasion

Question 15

Postoperative management of:

1. Papillary cancer
2. Follicular cancer
3. Medullary cancer
4. Undifferentiated

Answer 15

1. Thyroid hormone for suppression, and iodine ablation
2. Iodine ablation
3. None
4. Chemoradiation pre and post op

Question 16

Medullary cancer – monitor patients postoperatively by measuring?

Answer 16

Serum calcitonin CEA