Thyroid cancer Flashcards
what could ddx be for solitary thyroid nodule
cyst colloid nodule bengin follicular adenoma hyperplastic nodule papillary/follicular/medullary/anaplastic cancer lymphoma
how is a minimally invasive and vasular invasive follicular thyroid carcinoma managed
minimally invasive - lobectomy
invasion of vasculature or significant invasion then total thyroidectomy
what is the tumour cell marker in meduallary cell cancer
calcitonin
causes of medullary cell cancer?
sporadic, familial non MEN, or familial MEN
features of MEN2a?
MTC, hyperparathyroidism, phaeochromocytoma
how would you possibly manage MEN2a
prophylactic thyroidectomy as a child
biggest risk factor for thyroid lymphoma and how may it present
AA hypothyroidism
rapid onset mass in thyroid in female 70-80s
how would a lymphoma of the thyroid be managed
FNA or biopsy for histology then chemo, DXT, steroids, radiotherapy
what is the bethesda classification on FNA
thy1 inadequate thy2 benign thy3 atypical thy4 probs malignant thy5 malignant
how would you recognise a low risk papillary cell carcinoma and what is the management
<50 and tumour <4cm
lobectomy
lower TSH and baseline Tg to monitor
how would you recognise a high risk papillary cell carcinoma and what is the management
anything not in low risk category
total thyroidectomy with consiered radioactive iodine
TSH<1mU/L
annual Tg monitor as tumour cell marker
follow up for thyroid cancer
low risk may be discharged post 5y
get TSH/Tg for 6m for the first 5y and if not discharged then annually
what features may be seen on multinodular goitre on CT
retrosternal extension
tracheal deviation
when would you offer surgery for multinodular goitre causing issues
lifestyle interfering symptoms
stridor
tracheal compression and symptomatic
possibility of cancer
what does differentiated thyroid cancer refer to?
papillary and follicular cancers
risk factors for DTC
females
no association with diet, FHx, malignancy, smoking
ionising radiation exposure is the exception
investigation of DTC
USS FNA
excision biopsy of lymph node
pre op laryngoscopy if vocal cord palsy
why would a subtotal thyroidectomy be done over total
risk to damage of recurrent larygeal nerves
when would a total body iodine scan be done
3-6m post op subtotal or total thyroidectomy
describe the use of rhTSH and total body iodine scan
engineered to raise TSH<20
monday/tuesday IM injection
on wed give I-131
image on fri
what would you see on a total body iodine scan
physiological uptake into salivary glands, pituitary and concentration in stomach and bladder
may see thyroid remnant in sub-total thyroidectomy
side effects of thyroid remnant ablation
sialadenitis
sore throat
how is thyroid remnant conducted
pre treatment with rhTSH and higher dose I-131
patient admitted to lead lined room, use of disposable cutlery, sheets and clothing are stored until deemed safe with little contact with visitors/nurses
what are the TSH/FT4 aims post radioactive remnant ablation
TSH<0.1mU/l
FT4<25
use throxine to suppress TSH but not too much to increase FT4
describe possibly issues in using Tg as a tumour marker post radioactive remnant ablation
need suppressed TSH
anti-Tg Ab may affect result if +ve
presure pre op as not all subjects secrete Tg
long term effects of I-131 ablation
small, but significant risk in AML in those with repeated high doses within 12m
how may recurring differentiated thyroid cancer present
lymphadenopathy - papillary
haematogenous mets - follicular
rising Tg or spotted on imaging - usually I-131 but also PET
what is the recurrence rate of differentiated thyroid cancer
30%
management of DTC refractory to I-131 management
sorafenib, lenvatinib
tyrosine kinase inhibitors thought to be of benefit
small patient evidence base
