Thyroid cancer

Question 1

What are the four histological classifications of thyroid cancer?

Answer 1

Paillary

Follicular

Medullary

Anaplastic

Question 2

What does differentiated thyoid cancer mean?

Answer 2

Papillary or Follicular variant

Question 3

What do Differentiated thyroid cancers produce?

Answer 3

Take up iodine and secrete thyroglobulin

Question 4

How do people with differentiated thyroid cancer present?

Answer 4

Majority with palpable nodules

Question 5

What are the characterisitcs of papillary thyroid cancer?

Answer 5

Tends to spread via lymphatics

Haematogenous spread to lungs, bone liver and brain

Associated with hashimoto’s thyroidits

Prognosis generally good

Question 6

What is the go to investigation in suspected thyroid cancer?

Answer 6

ultrasound guided fine needle aspirate

Question 7

What are the clincial predictors of malignancy?

Answer 7

New thyroid nodule in a patient <20 or >50

Nodule increasing in size

Lesion >4cm

History of head and neck irritation

Vocal cord palsy

Question 8

What is the best treatment for thyroid cancer?

Answer 8

Surgery

Question 9

What does AMES stand for and what is it used for?

Answer 9

Used to measure risk in Thyroid cancers

A-age

M- metastases

E- Extent of primary tumour

S- size of primary tumour

Question 10

What makes you high risk in AMES?

Answer 10

All patients with distant metastases

or

tumour greater than 5cm in older patients

Question 11

What is appropriate post operative care in thyroidectomy

Answer 11

Calcium checked within 24hrs

Patient discharged on T3 and T4

Question 12

When should calcim levels be corrected?

Answer 12

Calcium replacement - < 2 mmol/L

IV calcium - 1.8 mmol/L or if symptomatic