Thyroid Cancer

Question 1

WHat is the presentation of a THyroglossal duct cyst?

Answer 1

A midline cyst anywhere in line between the tongue and the sternal notch

Question 2

How is the area for incision found for thyroid surgery?

Answer 2

Two finger widths up from the sternal notch, at a skin fold

Deep to the strap muscles at the 2nd-3rd ring of tracheal cartilage

Question 3

What is the artery that can be at a tracheosotmy site?

Answer 3

Midline (ILA) artery????

Question 4

WHat are the veins that drain the thyroid?

Answer 4

Superior, middle and inferior thyroid vein

Question 5

What does the recurrent laryngeal nerve loop around on each side? What does it innervate?

Answer 5

Under subclavian on the right, under the aorta on the left.

Innervates all the intrinsic muscles to the larynx.

Question 6

What are the types of thyroid nodules?

Answer 6

Cyst
Adenoma
Colloid nodule
Thyroiditis 
Infections
Devt abnormalities
Carcinoma
Thyroid Lymphoma

Question 7

How is thyroid cancer diagosed?

Answer 7

Good Hitory 
PE/US of neck/CT if enlarged LN
THyroid nodules not often malignant (common)
Fine needle aspiration
FNAB has a False neg of 1%

Question 8

WHat can an ultrasound tell you about the Thyroid and cancer?

Answer 8

Solid vs cystic
homo vs heterogeneous
multinodular gland
screening for high risk pts 
Guidance for biopsy

Question 9

How is fine needle aspiration used in Thyroid Cancer?

Answer 9

In office or radiology
Cells sent for cytology
Cyst may be aspirated
Cytology may be benign, indeterminite or malignant

Question 10

How is the radionucleide scan used in thyroid cancer?

Technecium 99

Answer 10

Hypofunctioning- Cold nodule
Hyperfunctioning- Hot nodule
Cold nodule more likley to be malignant

Question 11

How is thyroid Cancer Classified?

Answer 11

Differentiated
Papillary
Follicular
Hurthle cell

Undifferentiated
anaplastic?
C cell
Medullary Thyroid CA

Question 12

What are the consierations of Papillary CA of the thyroid?

Answer 12

Psammoma bodies on histology
good prognosis
Lobectomy

Question 13

What are the consierations of Follicular CA of the thyroid?

Answer 13

One solitary mass

Can mets to bone or CNS

Question 14

What are the consierations of Hurthle Cell CA of the thyroid?

Answer 14

Follicular Variant
May need to ask patient if they are ok with 2 surgeries
Usually need resection for accurate assessment

Question 15

What are the consierations of Medullary CA of the thyroid?

Answer 15

Neuroendocrine tumor of paragollicular or C cells
Pheochromocytoma (check metanephrines)
MEN 2A/2B
No role for thyroid supression (C cells not responsive to TSH)
Ask about Family history
Secretes Calcitonin

Question 16

What are the consierations of Anaplastic CA of the thyroid?

Answer 16

Aggressive
7-8th decade
Rapidly enlarging, painful
Chemoradiation
Poor prognois
All are considered Stage VI

Question 17

What are the consierations of Lymphoma of the thyroid?

Answer 17

Good prognosis

Question 18

What is the surgical treatment of THyroid Cancer?

Answer 18

Lower recurrence rates with total thyroidectomy
Easier to follow Pt if radioactive iodine is used (check for THyroglobulins)
Need to be on lifetime thyroid replacement therapy

Question 19

What are the avantages of a total thyroidectomy?

Answer 19

Leaves Parathyroid gland

Allows post-op radioactive Iodine###

Question 20

What are considerations in LN dissection in thyroid cancer?

Answer 20

More important if there's a large primary mass
###

Question 21

What are post op complications?

Answer 21

Hematoma - Depends on the size(even small bleed may obstruct trachea)
External branch of sup lar nerve (most common)
Recurrent lar nerve injury (most dreaded)
Hypocalcemia(total thyroidectomy)
-devascularization of the parathyroid
-Chvostecks(face) or THoroughs(arm)sign

Question 22

When do you do a biopsy of the possible thyroid cancer?

Answer 22

Greater than 1 cm in size
Heterogeneous
Family history