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Endocrine > Thyroid Cancer > Flashcards

Thyroid Cancer Flashcards

1
Q

What is the cause of a thyroglossal duct cyst?

A

Ectopic thyroid tissue and/or cysts present along the course of the thyroglossal duct

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2
Q

What is the difference between a thyroglossal duct cyst, and a cervical cyst?

A

Thyroglossal is midline

Cervical is lateral to the SCM

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3
Q

What muscle lie in front of the thyroid? (4)

A

Strap muscles:

  • Thyrohyoid
  • Sternothyroid
  • Sternohyoid
  • Omohyoid
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4
Q

What is the blood supply to the thyroid? (2)

A

Superior thyroid –external carotid artery

Inferior thyroid artery – thyrocervical trunk

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5
Q

What is the thyroid IMA, and when is it important?

A

Artery from the thyrocervical trunk that runs anteriorly along the trachea to the thyroid.

Need to know if tracheostomy

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6
Q

What is the blood supply to the superior pole of the thyroid? What is this a branch of?

A

Superior thyroid artery

External carotid artery

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7
Q

What is the middle thyroid artery a branch of?

A

There is no middle thyroid artery

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8
Q

What are the veins that drain the thyroid?

A

Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein

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9
Q

What is the nerve that runs alongside the thyroid within the carotid sheath?

A

CN X

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10
Q

The inferior thyroid vein drains where?

A

Into the brachiocephalic cein

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11
Q

The superior thyroid vein drains what part of the thyroid? Where does it drain to?

A

Drains the superior pole

Drains into the IJV

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12
Q

What middle thyroid vein drains what part of the thyroid? Where does it drain to?

A

Drains the lateral aspect of the gland

Drains into the IJV

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13
Q

Where does the recurrent laryngeal nerve lie in relation to the thyroid?

A

Deep to it– in the tracheoesophageal groove

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14
Q

What is the course of the vagus nerve on the right side? Left side?

A

Right = wraps around the thyrocervical trunk

Left = wraps around the arch of the aorta

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15
Q

What does the recurrent laryngeal nerve innervate?

A

All intrinsic muscles to the larynx except the cricothyroid muscle

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16
Q

What is the groove that the recurrent laryngeal nerves runs in?

A

Tracheoesophageal groove

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17
Q

What artery does the recurrent laryngeal nerve run near?

A

Inferior thyroid artery

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18
Q

True or false: there is a high incidence of asymptomatic thyroid nodules

A

True

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19
Q

What are the two major types of thyroid nodules?

A

Solitary nodules

Multinodular goiter

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20
Q

What is the risk of malignancy for solitary thyroid nodules?

A

5%

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21
Q

What is the risk of malignancy for a multinodular goiter?

A

1%

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22
Q

What are the characteristics of multinodular goiters (all similar, or all different)?

A

Multiple palpable nodules of similar size and consistency

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23
Q

What should always be asked about in the history when evaluating a thyroid nodule?

A

h/o radiation to the head/neck

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24
Q

What percent of thyroid nodules are malignant?

A

10%

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25
Q

What is the most effective method of diagnosing thyroid nodules? What is the false negative rate of this?

A

FNAB

False negative = 1% ish

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26
Q

What is most suspicious for malignancy: a homogenous or a heterogeneous thyroid nodule

A

Heterogeneous

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27
Q

True or false: a FNA can be done in the office setting or with radiology

A

True

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28
Q

Which is more likely malignant: hot or cold nodules?

A

Cold

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29
Q

What percent of all cancers in the US are thyroid cancers? What percent of all endocrine cancers are thyroid cancers?

A

1.5% of all CAs

95 of endocrine CAs

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30
Q

What are the four types of thyroid cancers in descending order of incidence/badness?

A

Papillary
Follicular
Medullary
Anaplastic

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31
Q

What are the three differentiated types of thyroid cancer?

A
  • Papillary
  • Follicular
  • Hurthle cell
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32
Q

Which thyroid cancer is made up of undifferentiated cells?

A

Anaplastic

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33
Q

What cancer of the thyroid may/may not be primary?

34
Q

True or false: surgery is the best option for anaplastic thyroid carcinoma

A

False– way too metastatic

35
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

36
Q

What is the prognosis for papillary CA?

37
Q

What is the treatment for papillary thyroid cancer?

A

Thyroidectomy or lobectomy

38
Q

What is the histological characteristic of papillary cancer?

A

Psammoma bodies

39
Q

What thyroid cancer has psammoma bodies?

A

Papillary cancer

40
Q

Who usually gets follicular cancer?

A

60-70 year olds

41
Q

What type of masses are follicular thyroid cancers?

42
Q

What determines if a follicular cancer is benign or not?

A

If it has penetrated the capsule

43
Q

How does follicular cancer spread? Where does it usually met to (4)?

A 
Hematogenously
Bone
Lung
Liver 
CNS
44
Q

What is the treatment for follicular cancer?

A

Lobectomy plus isthmusectomy if local

If invaded capsule, then total thyroidectomy

45
Q

When is a total thyroidectomy indicated for follicular cancer?

A

If cancer spreads outside the capsule

46
Q

What is Hurthle cell cancer? How do you diagnose this?

A

Variant of follicular thyroid cancer

Need full biopsy

47
Q

What is medullary thyroid cancer?

A

A neuroendocrine tumor of the parafollicular (C cells) of the thyroid gland

48
Q

What type of cancer arises from the C cells of the thyroid?

A

Medullary thyroid cancer

49
Q

What is the genetic disease that causes medullary thyroid cancer?

50
Q

What percent of medullary thyroid cancers are sporadic?

51
Q

What are the two markers of medullary thyroid cancer?

A

Elevated calcitonin and CEA

52
Q

What two diseases must be screened for with medullary thyroid cancer?

A

Pheochromocytoma and hyperparathyroidism

53
Q

What are the three cancers that are associated with MEN1?

A
  • Pituitary adenoma
  • Parathyroid hyperplasia
  • Pancreatic tumors
54
Q

What are the three cancers associated with MEN2A?

A
  • Parathyroid hyperplasia
  • Medullary thyroid CA
  • Pheochromocytoma
55
Q

What are the three cancers that are associated with MEN2B?

A
  • Mucosal neuromas
  • Medullary thyroid carcinoma
  • Pheochromocytoma
56
Q

Which type of MEN has marfanoid body habitus?

57
Q

What is the treatment for medullary thyroid cancer?

58
Q

What is the role of radioiodine therapy with medullary thyroid cancer?

A

Not responsive

59
Q

What is the role of thyroid suppression with medullary thyroid cancer?

A

None since C cells are not responsive to TSH

60
Q

What is the marker that is followed after surgery for medullary thyroid cancer?

A

Calcitonin

61
Q

What is the most aggressive of the thyroid cancers?

A

Anaplastic cancer

62
Q

Who usually gets anaplastic cancer?

63
Q

What are the ssx of anaplastic cancer?

A

rapidly enlarging, painful, symptomatic thyroid mass, impinging on the esophagus and the trachea

64
Q

What is the treatment for anaplastic thyroid cancer?

65
Q

What is the mean survival time of anaplastic thyroid cancer?

A

3-6 months

66
Q

How do you diagnose lymphoma to the thyroid?

67
Q

What is the treatment for lymphoma of the thyroid?

A

Radiation and chemo

68
Q

What is the 5 year survival rate of lymphoma?

69
Q

Which two of the thyroid cancers are amenable to surgical treatment?

A

Papillary and follicular

70
Q

What is the size of the tumor that indicates that a lobectomy is preferential to a total thyroidectomy?

A

Less than 1 cm

71
Q

How do you follow patients who have had a total thyroidectomy?

A

Monitor thyroglobulin levels

72
Q

What do you do if you accidentally take out the parathyroid glands?

A

Chop it up and put it into the SCM

73
Q

What is the role of radioablation after a total thyroidectomy?

A

Get any remaining cells

74
Q

True or false: any lymph nodes that are positive for cancer should be removed

75
Q

When, besides having positive lymph nodes, should nodes be removed?

A

Poor prognostic features

76
Q

Why are hematomas particularly concerning with thyroidectomies?

A

Large hematomas can cause respiratory distress

77
Q

What is the most common nerve injured in a total thyroidectomy? What nerve produces the least desirable effects?

A

External branch of the superior laryngeal nerve is most hit

Recurrent laryngeal nerve is most deadly

78
Q

What are the ssx of nicking the recurrent laryngeal nerve?

A

Hoarseness or total airway compromise if both

79
Q

What are the complications that can arise from damaging the external branch of the superior laryngeal nerve?

A

Pitches may not be able to be reached

80
Q

What is Chvostek’s sign?

A

tapping in CN VII causes spasm with hypocalcemia

81
Q

What is Trousseaus’s sign?

A

BP cuff inflation causes arm spasm with hypocalcemia

82
Q

When is thyroid supplementation started after a total thyroidectomy?

A

After f/u with endocrinology

Endocrine (32 decks)

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