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Endocrinology > Thyroid Cancer > Flashcards

Thyroid Cancer Flashcards

1
Q

what are the 5 histological classes of thyroid cancer?

A
  • papillary
  • follicular
  • medullary
  • anaplastic
  • other
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2
Q

what are the 2 most common types of thyroid cancer?

A

papillary

follicular

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3
Q

what does a medullary thyroid cancer secrete?

A

calcitonin

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4
Q

what is the prognosis like of anapaestic thyroid cancer?

A

very poor

almost anyone who gets it dies within a few months

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5
Q

what does the term differentiated thyroid cancer refer to?

A

papillary & follicular variants

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6
Q

what does the term differentiated refer to?

A

histological appearance but also to physiological characteristics that allow diagnosis & treatment

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7
Q

what do most DTCs take up?

A

iodine

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8
Q

what do most DTCs secrete?

A

thyroglobulin

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9
Q

what are DTCs driven by?

A

TSH

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10
Q

is thyroid cancer common or not?

A

not common at all

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11
Q

does DTC have higher or lower incidence in afro-americans?

A

lower

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12
Q

what does DTC have a strong association with?

A

radiation e.g. treatment for lymphoma

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13
Q

how do the majority of DTCs present?

A

palpable nodules

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14
Q

what is the commonest histological type of thyroid cancer?

A

papillary

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15
Q

how does papillary thyroid cancer commonly spread?

A

via lymphatics

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16
Q

where would a haematogenous spread likely go?

A

lungs
bone
liver
brain

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17
Q

which thyroiditis is papillary thyroid cancer associated with?

A

hashimoto’s thyroiditis

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18
Q

what is the second commonest type of DTC?

A

follicular carcinoma

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19
Q

in which regions is the incidence of follicular carcinoma slightly more common?

A

regions of relative iodine deficiency

20
Q

follicular carcinoma is spreads more commonly through which system?

A

haematogenously

21
Q

in which type of DTC are you more likely to find lymph node enlargement?

A

papillary

22
Q

what is the most common 1st line investigation for suspected thyroid cancer?

A

ultrasound guided FNA of the lesion

23
Q

FNA

A

fine needle aspiration

24
Q

what is the 2nd most common investigation of thyroid cancer?

A

excision biopsy of lymph node

25
Q

what investigation should a patient be sent for pre-operatively if vocal cord palsy is suspected clinical?

A

pre-operative laryngoscopy

26
Q

what are the surgical options for thyroid cancer treatment?

A

thyroid lobectomy with isthmusectomy
sub-total thyroidectomy
total thyroidectomy

27
Q

how is surgical risk assessed?

A 
AMES
Age 
Metastases
Extent of primary tumour 
Size of primary tumour
28
Q

what is the most common complication of thyroid surgery & why?

A

hypocalcaemia due to inadvertent removal of all parathyroid glands

29
Q

in which patients is whole body iodine scanning used in?

A

patients who have undergone sub-total or total thyroidectomy

30
Q

how long after an operation is whole body iodine scanning usually performed?

A

3-6 months

31
Q

for how long before the whole body iodine scan is T4 stopped?

A

4 weeks prior

32
Q

for how long before the whole body iodine scan is T3 stopped?

A

2 weeks prior

33
Q

what level should TSH be at for whole body iodine scanning to be effective?

A

greater than 20

34
Q

rhTSH

A

genetically made TSH aka thyrogen

35
Q

what is the benefit of hTSH injections?

A

gives short rise in TSH levels without stopping thyroxin, no change in symptoms

36
Q

where is iodine normal taken up in the body?

A

salivary glands
stomach
bladder (excreted via kidney)

37
Q

TRA

A

thyroid remnant ablation

38
Q

when is TRA used?

A

in those with residual disease

39
Q

which protein can be used as a thyroid tumour marker after TRA?

A

thyroglobulin

40
Q

which cells produce thyroglobulin?

A

normal thyroid cells

DTC cells

41
Q

what should the serum thyroglobulin level be in a patient who is cured of DTC?

A

undetectable

42
Q

why would you do TRA?

A

to ablate residual thyroid tissue in order to destroy occult microfoci

43
Q

what are patient’s biochemical picture like after TRA?

A

hyperthyroid

44
Q

at what level does hyperthyroidism after TRA become risky?

A

30+

45
Q

what does hyperthyroidism of 30+ increase the risk of?

A

osteoporosis & AF

46
Q

what is the absolute contraindication to TRA?

A

pregnancy

Endocrinology (23 decks)

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