Thyroid

Question 1

What are thyroglossal cysts?

Answer 1

Thyroglossal tract remnants found along the course of descent of the thyroid gland
- duct normally disappears but if some tissue remains then a cyst can develop

Question 2

Mean age of presentation of thyroglossal cyst

Answer 2

Normally in children or adolescents - mean age is age 5 but can be any time from 4months to 70 years

Question 3

Presentation of thyroglossal cyst

Answer 3

Midline lump, mostly asymptomatic but in 5% may be tenderness or rapid enlargement due to infection

Question 4

Examination of thyroglossal cyst

Answer 4

Will move up on protrusion of tongue and with swallowing

Transilluminate

Question 5

Management of thyroglossal cyst

Answer 5

Surgical excision of cyst and any duct remnant

Antibiotics if infected

Question 6

Which is the most common type of thyroid cancer

Answer 6

Papillary adenocarcinoma

Question 7

Features of thyroid papillary adenocarcinoma

Answer 7

Age 20-40 years
Well-differentiated. Seldom encapsulated.
Invade lymphatics early - haematogenous mets is rare
Good prognosis

Question 8

Histology for thyroid papillary carcinoma

Answer 8

Diagnosed of FNAC

show ‘orphan Annie” nuclei (pale empty nuclei) and papillary projections

Question 9

What is a risk factor for thyroid papillary

Answer 9

Childhood radiation exposure

Question 10

What thyroid cancer has presentation age 40-50

Answer 10

Follicular adenocarcinoma

Question 11

Features of follicular thyroid cancer

Answer 11

Spread haematologically to lung and bone therefore worse prognosis

Question 12

Diagnosis of follicular thyroid cancer

Answer 12

Can’t be diagnosed accurately by FNAC therefore need hemi-thyroidectomy. May appear macroscopically encapsulated but microscopically - capsular invasion is seen.

Question 13

Features of medullary thyroid adenocarcinomas

Answer 13

Part of MEN 2a+b

Both lymphatic and haematogenous mets. Nodal disease has poor prognosis

Question 14

What sort of tumour are medullary thyroid

Answer 14

Of parafollicular (C) cells - not thyroid tissue
Do not respond to iodine as not thyroid in origin
Spread to lymph and haematologically

Question 15

Tumour marker for medullary thyroid

Answer 15

Calcitonin (secreted by parafollicular c cells)

Question 16

Tumour marker for follicular and papillary thyroid cancer

Answer 16

Serum thyroglobulin

Question 17

Features of anaplastic thyroid carcinoma

Answer 17

Tend to occur in older age (females)
Most aggressive therefore poor prognosis
Usually just offer palliative - can do resection

Question 18

Management of papillary and follicular cancer

Answer 18

Total thyroidectomy and then radioiodine to kill residual cells
Yearly thyroglobulin levels to detect early recurrent disease

Question 19

Anaplastic thyroid carcinoma management

Answer 19

Treatment with resection where possible - palliation may be achieved through isthmusectomy (removal of lobe and isthmus) + radiotherapy.
Chemotherapy is ineffective