Thyroid 3

Question 1

A pt has medullary thyroid Ca, has positive lateral lymph nodes for mets, what surgery performed?

Answer 1

total thyroidectomy, lateral neck dissection and central neck dissection

once mets are seen in lateral LNs, chances are there is central lymph node involvement as well

Question 2

What tumor marker can we use to assess for disease recurrence in papillary thyroid cancer?

Answer 2

thyroglobulin

Question 3

What’s the tumor marker we measure for medullary thyroid ca?

Answer 3

calcitonin

Question 4

Describe acute suppurative thyroiditis?

Answer 4

can be seen in children or adults 20-40

can be caused by bacteria/fungi/parasites

s. aureus and s. pyogenes commonly implicated

FNA w/cytology, gram stain and culture, is best test

Question 5

For papillary thyroid cancer why is surgery a total thyroidectomy?

Answer 5

30% of cases can have multi-centric disease found throughout the gland

Question 6

On cytology if we see overlapping nuclei that are clear, we think?

Answer 6

orphan annie nuceli

assc w/papillary thyroid Ca

Question 7

80% of thyroid cancers are what type?

Answer 7

papillary

Question 8

Someone had papillary thyroid Ca, then had total thyroidectomy, and then their thyroglobulin levels increased a year later, what imaging test do we order?

Answer 8

neck US first–> most recurrence occur in neck

Question 9

Someone had medullary thyroid Ca in association with MEN2A, and had a total thyroidectomy, 3 days later their calcitonin levels are the same as they were before the surgery, what do you do?

Answer 9

reassure

can take several months for calcitonin levels to drop

Question 10

Papillary and follicular thyroid carcinoma, that are smaller than what size, can be managed with partial thyroidectomy;

Answer 10

smaller than 1 cm

medullary thyroid Ca needs total thyroidectomy regardless of size

Question 11

Are thyroid nodules in kids cancerous?

Answer 11

highest risk of cancer is in the young and old

in kids less than 14 with thyroid nodules, risk of Ca is 50%

Question 12

What’s the risk of thyroid Ca in kids less than 14 with thyroid nodules?

Answer 12

cancer risk is 50% in this age group

Question 13

What is subacute granulomatous thyroiditis?

Answer 13

assc with a painful thyroid and thyrotoxicosis

often followed by a transient hypothyroid state followed by complete recovery

initial hyperthyroid phase can have a systemic illness similar to influenza

shows low RAI uptake

Question 14

What is Riedel thyroiditis?

Answer 14

rare chronic inflammatory dx of thyroid

causes thyroid fibrosis

see a hard, non-tender thyroid

assc w/hypothyroidism

Question 15

Before we operate on someone with hyperthyroidism due to Grave’s dx for example, what needs to be done first?

Answer 15

they need anti-thyroid medications to control against thyroid storm occurring during or after surgery

Question 16

Do you biopsy a nodule that is 0.8 cm, with cystic structures, hyperechoic, w/smooth margins?

Answer 16

benign features, no

just observe

Question 17

For pts with RET proto-oncogene mutations (MEN12A) when is thyroidectomy recommended?

Answer 17

before age 1 or at the time of diagnosis

Question 18

What nerve is most injured during a thyroidectomy?

Answer 18

external branch of superior laryngeal nerve

it runs with superior thyroid artery; which is taken during thyroidectomy