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03- Endocrine > Thyroid Cancers > Flashcards

Thyroid Cancers Flashcards

1
Q

what are the two kinds of thyroid nodules?

A

solitary thyroid nodule

multinodular goitre

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2
Q

the vast majority of solitary thyroid nodules are benign/malignant?

A

benign- 95%

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3
Q

what are the four groups of benign solitary thyroid nodule?

A

cyst

colloid nodule

benign follicular adenoma

hyperplastic nodule

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4
Q

what are thegroups of malignant thyroid nodules?

A

papillary thyroid carcinoma

follicular thyroid carcinoma

medullary thyroid carcinoma

(lymphoma)

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5
Q

what confirms if the nodule is in the thyroid?

A

moves on swallowing

means it is invested in pre-tracheal fascia

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6
Q

is pain a common feature of thyroid nodules?

A

no- pain usually caused by intra thyroidal into a cyst

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7
Q

thyroid nodules are more common in men/women?

A

women

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8
Q

what percentage of women are diagnosed with a thyroid nodule?

A

5%

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9
Q

what important feature in the history will predispose to thyroid nodules?

A

neck irradiation

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10
Q

is there a familial pattern with thyroid nodules?

A

yes- mroe common in those with a family history of nodules

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11
Q

what two things are most important in the examination of thyroid nodules?

A

neck nodes- suggest papillary

Hoarseness- aggressive can cer liklely

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12
Q

which two investigations are carried out when dealing with thyroid nodules?

A

TSH- levels usually normal

US Fine needle aspirate

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13
Q

what are the two classifications used when grading thyroid nodules?

A

U2-5- BTA 2014 guidelines

Thy1-5 FNA Bethseda classification

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14
Q

what does Thy 1-5 indicate?

A
  • Thy1- just blood no cells
  • Thy2- benign
  • Thy3 (a/f)- atypical
  • Thy4- probs malignant
  • Thy5- malignant
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15
Q

what does U2-5 indicate?

A

U2- nothign indicated

U3- worried about features

U4/5- malignant

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16
Q

hiow many of those diagnosed with a thyroid nodule U3 will turn out to be malignant?

A

1/3rd will be malignant

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17
Q

what is DTC?

A

Differentiated Thyroid Cancers

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18
Q

who are the low risk group for DTCs?

A

under 50yrs

under 4cm

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19
Q

who are the high risk group for DTCs?

A

over 50yrs

over 4cm

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20
Q

what is the surgical managemetn of DTC in a low risk patient?

A

lobectomy

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21
Q

what is the surgival management of DTC in high risk patients?

A

total thyroidectomy

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22
Q

which hormones are measured post operatively as a marker of cancer reoccurence?

A

TSH

Thyroglobulin

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23
Q

how often are TSH/Tg measured post op?

A

every 6 months for first 5yrs then,

annually for next 5yrs

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24
Q

how do follicular thyroid cancers spread?

A

haematogenous spread

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25
Q

follicuar thyroid carcinomas make up what percentage of thyroid cancers?

A

10%

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26
Q

how are follicualr thryoid carcinomas (FTC) usually treated?

A

lobectomy

thyroidectomy if significant vascular invasion

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27
Q

thyroid lymphomas have a rapid onset in which pateint group?

A

femlaes aged 70-80

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28
Q

why do thyroid lymphomas affect elderly females mostly?

A

longstanding thyroxine treatment for autoimmune hypothyroidism

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29
Q

whcih condition is usually present in thryoid lymphoma?

A

autoimmune hypothyroidism

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30
Q

what procedure allows thyroid lymphomas to be diagnosed histologically?

A

core biopsy

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31
Q

following core biopsy of a thyroid lymphoma what is done for the patient?

A

steroids

chemo

radiotherapy

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32
Q

medullary thyroid carcicinoma is a tumour of which cells?

A

parafollicular cells

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33
Q

what is secreted by parafollicular cells that can be used as a tumour cell marker?

A

calcitonin

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34
Q

medullary thyroid carcinomas are common/rare

A

rare

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35
Q

the presence of what on FNA is used as diagnosis of medullary thyroid carcinoma?

A

amyloid

calcitonin

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36
Q

what are the four types of medullary thyroid carcinoma?

A

sporadic

familial non MEN

familial MEN (MEN2a)

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37
Q

what should always be checked with medullary thyroid carcinomas?

A

24hr urinary metanephrines

genetics

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38
Q

what tumour is highly associated with MTC?

A

phaechromocytoma

secretes adrenaline

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39
Q

what two tests should be carried out to assess function and structure with a multinodular goitre?

A

TSH -function

CT scan- structure

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40
Q

what is usually seen with TSH levels in multinodular goitre?

A

usually normal or slightly suppressed

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41
Q

what can CT scan show in a multinodular goitre?

A

retrosternal extension

tracheal compression

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42
Q

what is done to treat a multinodular goitre?

A

most left alone

RAI if sig hyperthyroid

Surgery is structural issue

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43
Q

Differentiated thyroid cancer refers to which two variants?

A

papillary

follicular

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44
Q

most DTCs take up _____ and secrete _____

A

take up iodine

secrete thyroglobulin

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45
Q

DTCs are driven by which hormone?

A

TSH

46
Q

DTCs have a better/poorer prognosis that other solid tumours?

A

better

47
Q

which thyroid cancer type is the msot common?

A

papillary

48
Q

how does papiallry thyroid cancer spread?

A

lympthatics

49
Q

post op (lobectomy/thyroidectomy) what needs to be checked within 24hrs?

A

calcium levels

50
Q

when is whole body iodine scanning used?

A

in patients who have undergone partial or total thyroidectomy 3-6 months post op

51
Q

how is whole body iodine scanning carried out?

A

given two injections to elevate TSH levels

capsule on wednesday of same week

imaging on friday reveals uptake of iodine in any cancer cells

52
Q

what is thyroid remnant ablation (TRA)?

A

dose of radioiodine that destroys any remainign thyroid cells (potential cancer cells)

53
Q

are people being treated with TRA allowed visitors?

A

yes- but have to sit further away and visit for less time

54
Q

how long do people usually have to stay in hosptial for when recieving TRA?

A

usually 48hr stay

55
Q

what percentage of the dose of TRA is excreted through the urrine within the first 24hrs?

A

80%

56
Q

what cps value must patients exhibit in order to be discharged after TRA?

A

<500cps

(counts per minute)

57
Q

what is the longterm management of a patient after recieving TRA?

A

maintained on T4

suppress TSH levels

58
Q

what is used as a ‘tumour marker’ after treatmetn with TRA?

A

thyroglobulin

59
Q

TRA doubles the risk of which condition?

A

myeloid leukemia

60
Q

has TRA been shown to cause infertility or genetic abnormalities in children?

A

No

61
Q

what is the recurrence rate in thyroid cancers?

A

30%

62
Q

what peripheral hormone pairs with ACTH?

A

cortisol

63
Q

which peripheral hormone pairs with TSH?

A

thyroxine

64
Q

which peripheral hormone pairs with LH/FSH?

A

testosterone

65
Q

which peripheral hormone pairs with Growth hormone?

A

IGF-1

66
Q

what is the only unpaired hormone?

A

prolactin

67
Q

what released from the hypothalmus inhibits prolactin?

A

dopamine

68
Q

in order of most to least common which direction is a pituitary tumour most likely to grow in?

A

superiorly

laterally

inferiorly

69
Q

why is most common for a pituitary tumour to grow superiorly?

A

bony structures everywhere else

70
Q

which structures can a laterally growing pituitary tumour interfere with?

A

cranial nerves in cavernous sinuses

71
Q

what can happen if a pituitary tumour grows down the way?

A

enter sphenoid sinus and leaky sinus sinus fluid

72
Q

what are dynamic tests?

A

tests that try to suppress/stimulate the hormone

73
Q

which dynamic test is used when overproduction of a hormone is suspected?

A

suppression test

74
Q

which dynamic test is used when underproduction of a hormone is suspected?

A

stimulation test

75
Q

what is the name given to a pituitary tumour <1cm?

A

microadenoma

76
Q

what is the name given to a pituitary tumour >1cm?

A

macroadenoma

77
Q

what is a non-functioning pituitary adenoma?

A

doesnt secrete anything

78
Q

what are some casues of raised prolactin?

A

hypothyroidism

breast feeding/pregnacy

stress

sleep

dopamine antagonists e.g metoclopramide

79
Q

who presents earlier with pituitary tumours? men/women

A

women- can present wth missed periods so noticed earlier

80
Q

what are investigations used to investigate prolactinoma?

A

prolactin conc

MRI pituitary

visual fields (bitemporal hemianopia)

81
Q

what is the treatment fro prolactinoma?

A

cabergoline (dostinex)

82
Q

excess growth hormone causes which condition?

A

acromegaly

83
Q

what are some common features of acromegaly?

A

sweaty

large hands

large jaw

hypertension

headaches

diabetes

snoring/sleep apnoea

84
Q

what is used to diagnose acromegaly?

A

IGF1

GTT

85
Q

what i steh treatment for acromegaly?

A

pituitary surgery

external radiotherapy to pituitary fossa

86
Q

what level of GH is staisfactory after treatment of acromegaly?

A

<0.4ug/l

87
Q

what level of GH requires drug therapy after treatment of acromegaly?

A

>1ug/l

88
Q

somatostatin anologues in acromegaly have been shown to decrese tumours by how much?

A

30-50% decrease in size

89
Q

what are some of the short term side effects of somatostatin analogues?

A

flatulence

diarrhoea

abdo pain

90
Q

what are some of the long term side effects of somatostatin analogues?

A

gastritis

gallstones

91
Q

give some examples of somatostatin analogues?

A

ocretide

sandostatin

lenreotide autogel

92
Q

which dopamine agonist can be used in acromegaly?

A

cabergoline- up to 3g weekly

93
Q

what kind of drig is pegvisomat?

A

GH antagonist

94
Q

what is teh first line treatment for prolactinoma?

A

dopamine agonist

95
Q

what condition is due to excess cortisol?

A

cushings syndrome

96
Q

what occur in cushings sndromen due to protein loss?

A

myopathy

osteoperosis

thin skin

97
Q

how can cushigns cause diabetes/obesity?

A

altered carbohydrate/lipid metabolism

98
Q

excess mineralcorticoid causes what in cushings?

A

hypertension

oedema

99
Q

cushings is characterised by?

A

thin skin

proximal myopathy

frontal balding in women

osteoperosis

100
Q

why were people with cushings described as ‘lemon on matchsticks’ in previous years?

A

inc abdominal fat

thin legs due to muscle wasting

101
Q

what dynamic test is used in cushings?

A

suppression test

102
Q

why are random cortisol levels rearely useful in making a diagnosi of cushings?

A

cortisol levels vary to much normally anyway `

103
Q

what supression test is used in diagnosing cushings?

A

overnoght 1mg dexamethasone

<50* nmol/l cortisol *normal

>100 nmol/l abnormal

104
Q

what is the diference between cushings syndrome and cushings disease?

A

disease- cause ois pituitary

syndrome- all others

105
Q

what are soem casues of cushings syndrome?

A

adenoma of adrenal

alcohol

steroids

106
Q

what is an hypopituitarism?

A

pituitary isnt peoducing all its hormones

107
Q

whta hornones does the anterior pituitary produce?

A

Growth Hormone

TSH

LH/FSH

ACTH

Prolactin

108
Q

what are some casues of hypopituitarism?

A

pituitary tumours

local brain tumours

granulomatous diseases (TB, sarcoidosis)

trauma (RA, skull fracture)

109
Q

what are some signs and symptoms of anterior hypopituitarism?

A

menstrual irregularities

infertilty

gynaecomastia

abdo obestity

loss of facial hair

dry skin/hair

110
Q

what are some replacement therapies for hypopituitarism?

A

thyroxine

hydrocortisone

ADH

GH

sex steroids

111
Q
A

03- Endocrine (9 decks)

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