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QUESTION NOTES > THYROID > Flashcards

THYROID Flashcards

1
Q

MEN 1 gene? Located on what Chr?

A

Menin. AD gene located on Chr 11.

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2
Q

First abnormality typically detected for MEN 1.

A

hyperCa 2/2 hyperPTH (nephrolithiasis)

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3
Q

Risk thyroid cancer highest in young vs. old, men vs. female?

A

highest in young AND old, 2x greater risk in men (excision indicated in men >60yo)

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4
Q

Genetic mutation associations: RET

A

familial medullary thyroid CA

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5
Q

Genetic mutation associations: PAX-8/PPARgamma

A

follicular thyroid CA

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6
Q

Genetic mutation associations: p53

A

anaplastic

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7
Q

Genetic mutation associations: BRAF

A

papillary

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8
Q

Mgmt thyroid lymphoma

A

chemotherapy (do not need surgery unless compressive sxs)

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9
Q

Mgmt diffuse large B-cell lymphoma

A

CHOP (cytoxan, hydroxy doxodubicin, oncovin, prednisone) + radiation

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10
Q

Bethesda criteria (6)

A

for FNA results

  1. benign = repeat exam in 6-12mo with US
  2. non-dx (suspicious US, benign FNA; discordinant) = repeat FNA
  3. follicular cell of indeterminate significance = repeat FNA
  4. follicular neoplasm = lobectomy
  5. suspicious for malignancy = lobectomy vs. total thyroidectomy
  6. malignant = lobectomy vs. total thyroidectomy
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11
Q

MC type thyroid cancer

A

papillary

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12
Q

Does lymphatic spread affect prognosis of papillary thyroid cancer?

A

NO. Local invasion does.

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13
Q

Path: papillary thyroid cancer

A
  • psammoma bodies

- orphan annie nuclei

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14
Q

Why total thyroidectomy for papillary thyroid cancer?

A
  1. removal of multifocal disease (common 30%), even if cannot see
  2. preparation for RAI therapy
  3. so can use thyroglobulin levels to test for recurrence
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15
Q

Germline mutations related to medullary thyroid cancer

A
  1. MEN 2A (RET)
  2. MEN 2B (RET)
  3. familial medullary thyroid cancer
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16
Q

Serum markers surveillance for medullary thyroid cancer

A

calcitonin (pentagastrin-stimulated peak plasma calcitonin) + CEA levels q6mo for 1 year, then annually

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17
Q

Anatomical variance associated w/ non-recurrent RIGHT laryngeal nerve

A

aberrant RIGHT subclavian artery (arteria dosoria)

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18
Q

Serum marker surveillance for papillary thyroid cancer

A

thyroglobulin

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19
Q

MC sxs of high level calcitonin in blood

A

diarrhea

20
Q

MEN2A: what age need prophylactic thyroidectomy?

A

6yo

21
Q

MEN2B: what age need prophylactic thyroidectomy

A

<2yo

22
Q

Superior thyroid artery runs adjacent to what nerve?

A

superior laryngeal nerve

23
Q

Inferior thyroid artery runs adjacent to what nerve?

A

recurrent laryngeal nerve (either anterior or posterior)

24
Q

Venous drainage of superior vs. middle vs. inferior thyroid veins

A

superior + middle -> IJ vein

inferior -> innominate veins

25
Q

Elevated calcitonin level >400, think…?

A

medullary thyroid cancer

26
Q

Leukocytosis + normal TFTs in setting of tender, enlarged nodule… think?

A

acute suppurative thyroiditis

27
Q

Mgmt acute suppurative thyroiditis

A

US-guided FNA w/ gram stain and Cx + Abx +/- drainage

28
Q

MC bacteria acute suppurative thyroiditis

A

staph aureus + strep pyogenes

29
Q

Most accurate and cost-effective assessment of thyroid nodules

A

FNA biopsy (PPV 97-99%)

30
Q

MEN 1 malignancies

A
  • pituitary adenoma
  • parathyroid hyperplasia
  • pancreatic tumor (MC gastrinoma)
31
Q

MEN 2A malignancies

A
  • parathyroid hyperplasia
  • medullary thyroid CA
  • pheo
32
Q

MEN 2B maligancies

A
  • medullary thyroid CA
  • pheo
  • mucosas neuromas + marfanoid body habitus
33
Q

Sxs postpartum thyroiditis

A

thyrotoxicosis (anxiety, palpitations, insomnia) -> hypothyroidism (can be Tx levothyroxine for 6-9mo, tapered)

34
Q

Suspicious sonographic features of thyroid nodule (5)

A
  • hypoechoic
  • microcalcifications
  • increased central vascularity
  • infiltrative margins
  • taller than wider in transverse palne
35
Q

Size indication for thyroid nodule to get FNA

A

> 1cm w/ suspicious US features OR >1.5cm wo features

36
Q

If AUS or FLUS… mgmt?

A

if low malignancy risk -> repeat FNA

if w/ RF -> lobectomy

37
Q

Fu for indeterminate FNA for follicular neoplasm + benign gene expression classifier (GEC)

A

repeat clinical exam + US at 1 year

38
Q

Operative mgmt pt w/ medullary thyroid carcinoma on FNA, but negative cervical US for nodes

A

total thyroidectomy + central LN dissection (bc high rate CLN involvement and high US false-neg)

39
Q

Who needs radioactive iodine Tx after total thyroidectomy?

A
  • tumor 2-4cm
  • vascular invasion
  • anti TG Ab
  • TG <5
  • also allows following TG levels to assess recurrence
40
Q

How to assess for recurrence of follicular thyroid CA?

A

follow TG levels

41
Q

What size thyroid nodule requires evaluation with FNA?

A
  • any solid thyroid nodule >/= 1.5cm size

- solid nodule >/= 1cm + suspicious features

42
Q

Suspicious features of thyroid nodule on US

A
  • hypoechoic
  • microcalcifications
  • infiltrative margins
  • taller than wider in transverse plane
43
Q

Tx after partial thyroidectomy for <1cm papillary thyroid CA

A

Thyroid hormone to suppress TSH + f/u with US

44
Q

For which papillary thyroid carcinoma is partial thyroidectomy (lobectomy) okay?

A
  • small, encapsulated (noninvasive) <1cm diameter
  • age <45
  • negative nodes
45
Q

Damage to the external branch of the superior laryngeal nerve results in…?

A

affects voice pitch (motor innervation to cricothyroid muscle, which tilts larynx during speaking)

46
Q

Damage to recurrent laryngeal nerve results in…?

A

airway compromise (innervates posterior cricoarytenoid muscles)

47
Q

What size solid thyroid nodule requires evaluation with FNA?

A

> /= 1.5cm

Eval >/= 1cm only if + suspicious features

QUESTION NOTES (28 decks)

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