thyroid cancers

Question 1

who usually gets thyroid lymphoma

Answer 1

females aged 70-80

Question 2

what do patients with thyroid lymphoma often have a history of

Answer 2

auto-immune hypothyroidism

Question 3

clinical presentation of thyroid lymphoma

Answer 3

rapid onset mass in thyroid

Question 4

investigation of thyroid lymphoma

Answer 4

core biopsy

Question 5

management of thyroid lymphoma

Answer 5

chemo (R-CHOP), radiotherapy or steroids

Question 6

what is medullary carcinoma

Answer 6

tumour of c-cells

Question 7

what are c-cells

Answer 7

parafollicular cells which secrete calcitonin

Question 8

what are the majority of medullary carcinomas caused by

Answer 8

sporadic

Question 9

what can medullary carcinomas be associated with

Answer 9

MEN2

Question 10

genetic feature of medullary carcinomas

Answer 10

Germline RET mutations

Question 11

clinical presentation of medullary carcinoma

Answer 11

neck mass with local effects
diarrhoea
cushings

Question 12

name 3 local effects associated with a neck mass

Answer 12

dysphagia, hoarseness, airway compromise

Question 13

investigations for medullary carcinoma

Answer 13

fine needle biopsy guided by US
serum base calcitonin
24 hour urinary metanephrines
genetic screening for MEN

Question 14

local management of medullary carcinoma

Answer 14

total thyroidectomy

Question 15

management of advanced medullary carcinoma

Answer 15

may involve tyrosine kinase inhibitors

Question 16

what is anaplastic carcinoma

Answer 16

Undifferentiated and aggressive tumours derived from follicular epithelium

Question 17

genetic mutations associated with anaplastic carcinoma

Answer 17

p53 and β-catenin mutations

Question 18

clinical presentation of anaplastic carcinoma

Answer 18

• Thyroid nodule
• Features of local infiltration/compression
• Cervical lymphadenopathy
• Signs of distant metastases

Question 19

what can be used to confirm anaplastic carcinoma

Answer 19

US-FNA or biopsy

Question 20

management of anaplastic carcinoma

Answer 20

total thyroidectomy +/- adjuvant radiochemotherapy

Question 21

what is the most common type of thyroid cancer

Answer 21

papillary carcinoma

Question 22

what is papillary carcinoma associated with (2)

Answer 22

hashimoto’s thyroiditis
ionising radiation

Question 23

what is the second most common thyroid cancer

Answer 23

follicular carcinoma

Question 24

genetic associations with papillary carcinoma

Answer 24

BRAF, ras, RET

Question 25

who is more likely to get follicular carcinoma

Answer 25

40-50 yr females

Question 26

where is there a higher incidence of follicular carcinoma

Answer 26

regions of iodine deficiency

Question 27

genetic associations with follicular carcinoma

Answer 27

PI3K/AKT, ras

Question 28

what is associated with psammoma bodies

Answer 28

papillary carcinoma

Question 29

histology of follicular carcinoma

Answer 29

slowly enlarging, painless, non-functional tumour

Question 30

how do papillary carcinomas tend to spread

Answer 30

via lymphatics

Question 31

how do follicular carcinomas tend to spread

Answer 31

haematogenous

Question 32

investigation of papillary and follicular carcinoma

Answer 32

US-FNA

Question 33

management of thyroid cancer in low risk patients

Answer 33

thyroid lobectomy

Question 34

management of thyroid cancer in high risk patients

Answer 34

subtotal/total thyroidectomy consider radioactive iodine

Question 35

who gets whole body iodine scanning

Answer 35

patients who have had sub-total or total thyroidectomy

Question 36

what is whole body iodine scanning used for

Answer 36

to determine incomplete incision or present of occult metastases inform need for further investigation/ treatment

Question 37

role of RAI ablation in the management of thyroid cancer

Answer 37

Ablate residual thyroid tissue in order to destroy occult microfoci

Question 38

possible complication of RAI ablation

Answer 38

Small but significant incidence of acute myeloid leukaemia

Question 39

what is follicular adenoma

Answer 39

benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous (collagenous) capsule

Question 40

who usually gets follicular adenoma

Answer 40

women, incidence increases with age

Question 41

what is associated with follicular adenoma

Answer 41

increased incidence in regions of iodine deficiency

Question 42

genetic factors associated with follicular adenoma

Answer 42

mutant ras or PIK3CA

Question 43

what can follicular adenoma develop into

Answer 43

toxic adenoma

Question 44

clinical presentation of follicular adenoma

Answer 44

discrete solitary mass in an otherwise normal thyroid gland may present with local symptoms

Question 45

investigations for follicular adenoma

Answer 45

US-FNA, serum TSH

Question 46

management of follicular adenoma

Answer 46

lobectomy with biopsy