Thyroid Cancers Flashcards
what are the two kinds of thyroid nodules?
solitary thyroid nodule
multinodular goitre
the vast majority of solitary thyroid nodules are benign/malignant?
benign- 95%
what are the four groups of benign solitary thyroid nodule?
cyst
colloid nodule
benign follicular adenoma
hyperplastic nodule
what are thegroups of malignant thyroid nodules?
papillary thyroid carcinoma
follicular thyroid carcinoma
medullary thyroid carcinoma
(lymphoma)
what confirms if the nodule is in the thyroid?
moves on swallowing
means it is invested in pre-tracheal fascia
is pain a common feature of thyroid nodules?
no- pain usually caused by intra thyroidal into a cyst
thyroid nodules are more common in men/women?
women
what percentage of women are diagnosed with a thyroid nodule?
5%
what important feature in the history will predispose to thyroid nodules?
neck irradiation
is there a familial pattern with thyroid nodules?
yes- mroe common in those with a family history of nodules
what two things are most important in the examination of thyroid nodules?
neck nodes- suggest papillary
Hoarseness- aggressive can cer liklely
which two investigations are carried out when dealing with thyroid nodules?
TSH- levels usually normal
US Fine needle aspirate
what are the two classifications used when grading thyroid nodules?
U2-5- BTA 2014 guidelines
Thy1-5 FNA Bethseda classification
what does Thy 1-5 indicate?
- Thy1- just blood no cells
- Thy2- benign
- Thy3 (a/f)- atypical
- Thy4- probs malignant
- Thy5- malignant
what does U2-5 indicate?
U2- nothign indicated
U3- worried about features
U4/5- malignant
hiow many of those diagnosed with a thyroid nodule U3 will turn out to be malignant?
1/3rd will be malignant
what is DTC?
Differentiated Thyroid Cancers
who are the low risk group for DTCs?
under 50yrs
under 4cm
who are the high risk group for DTCs?
over 50yrs
over 4cm
what is the surgical managemetn of DTC in a low risk patient?
lobectomy
what is the surgival management of DTC in high risk patients?
total thyroidectomy
which hormones are measured post operatively as a marker of cancer reoccurence?
TSH
Thyroglobulin
how often are TSH/Tg measured post op?
every 6 months for first 5yrs then,
annually for next 5yrs
how do follicular thyroid cancers spread?
haematogenous spread
follicuar thyroid carcinomas make up what percentage of thyroid cancers?
10%
how are follicualr thryoid carcinomas (FTC) usually treated?
lobectomy
thyroidectomy if significant vascular invasion
thyroid lymphomas have a rapid onset in which pateint group?
femlaes aged 70-80
why do thyroid lymphomas affect elderly females mostly?
longstanding thyroxine treatment for autoimmune hypothyroidism
whcih condition is usually present in thryoid lymphoma?
autoimmune hypothyroidism
what procedure allows thyroid lymphomas to be diagnosed histologically?
core biopsy
following core biopsy of a thyroid lymphoma what is done for the patient?
steroids
chemo
radiotherapy
medullary thyroid carcicinoma is a tumour of which cells?
parafollicular cells
what is secreted by parafollicular cells that can be used as a tumour cell marker?
calcitonin
medullary thyroid carcinomas are common/rare
rare
the presence of what on FNA is used as diagnosis of medullary thyroid carcinoma?
amyloid
calcitonin
what are the four types of medullary thyroid carcinoma?
sporadic
familial non MEN
familial MEN (MEN2a)
what should always be checked with medullary thyroid carcinomas?
24hr urinary metanephrines
genetics
what tumour is highly associated with MTC?
phaechromocytoma
secretes adrenaline
what two tests should be carried out to assess function and structure with a multinodular goitre?
TSH -function
CT scan- structure
what is usually seen with TSH levels in multinodular goitre?
usually normal or slightly suppressed
what can CT scan show in a multinodular goitre?
retrosternal extension
tracheal compression
what is done to treat a multinodular goitre?
most left alone
RAI if sig hyperthyroid
Surgery is structural issue
Differentiated thyroid cancer refers to which two variants?
papillary
follicular
most DTCs take up _____ and secrete _____
take up iodine
secrete thyroglobulin
DTCs are driven by which hormone?
TSH
DTCs have a better/poorer prognosis that other solid tumours?
better
which thyroid cancer type is the msot common?
papillary
how does papiallry thyroid cancer spread?
lympthatics
post op (lobectomy/thyroidectomy) what needs to be checked within 24hrs?
calcium levels
when is whole body iodine scanning used?
in patients who have undergone partial or total thyroidectomy 3-6 months post op
how is whole body iodine scanning carried out?
given two injections to elevate TSH levels
capsule on wednesday of same week
imaging on friday reveals uptake of iodine in any cancer cells
what is thyroid remnant ablation (TRA)?
dose of radioiodine that destroys any remainign thyroid cells (potential cancer cells)
are people being treated with TRA allowed visitors?
yes- but have to sit further away and visit for less time
how long do people usually have to stay in hosptial for when recieving TRA?
usually 48hr stay
what percentage of the dose of TRA is excreted through the urrine within the first 24hrs?
80%
what cps value must patients exhibit in order to be discharged after TRA?
<500cps
(counts per minute)
what is the longterm management of a patient after recieving TRA?
maintained on T4
suppress TSH levels
what is used as a ‘tumour marker’ after treatmetn with TRA?
thyroglobulin
TRA doubles the risk of which condition?
myeloid leukemia
has TRA been shown to cause infertility or genetic abnormalities in children?
No
what is the recurrence rate in thyroid cancers?
30%
what peripheral hormone pairs with ACTH?
cortisol
which peripheral hormone pairs with TSH?
thyroxine
which peripheral hormone pairs with LH/FSH?
testosterone
which peripheral hormone pairs with Growth hormone?
IGF-1
what is the only unpaired hormone?
prolactin
what released from the hypothalmus inhibits prolactin?
dopamine
in order of most to least common which direction is a pituitary tumour most likely to grow in?
superiorly
laterally
inferiorly
why is most common for a pituitary tumour to grow superiorly?
bony structures everywhere else
which structures can a laterally growing pituitary tumour interfere with?
cranial nerves in cavernous sinuses
what can happen if a pituitary tumour grows down the way?
enter sphenoid sinus and leaky sinus sinus fluid
what are dynamic tests?
tests that try to suppress/stimulate the hormone
which dynamic test is used when overproduction of a hormone is suspected?
suppression test
which dynamic test is used when underproduction of a hormone is suspected?
stimulation test
what is the name given to a pituitary tumour <1cm?
microadenoma
what is the name given to a pituitary tumour >1cm?
macroadenoma
what is a non-functioning pituitary adenoma?
doesnt secrete anything
what are some casues of raised prolactin?
hypothyroidism
breast feeding/pregnacy
stress
sleep
dopamine antagonists e.g metoclopramide
who presents earlier with pituitary tumours? men/women
women- can present wth missed periods so noticed earlier
what are investigations used to investigate prolactinoma?
prolactin conc
MRI pituitary
visual fields (bitemporal hemianopia)
what is the treatment fro prolactinoma?
cabergoline (dostinex)
excess growth hormone causes which condition?
acromegaly
what are some common features of acromegaly?
sweaty
large hands
large jaw
hypertension
headaches
diabetes
snoring/sleep apnoea
what is used to diagnose acromegaly?
IGF1
GTT
what i steh treatment for acromegaly?
pituitary surgery
external radiotherapy to pituitary fossa
what level of GH is staisfactory after treatment of acromegaly?
<0.4ug/l
what level of GH requires drug therapy after treatment of acromegaly?
>1ug/l
somatostatin anologues in acromegaly have been shown to decrese tumours by how much?
30-50% decrease in size
what are some of the short term side effects of somatostatin analogues?
flatulence
diarrhoea
abdo pain
what are some of the long term side effects of somatostatin analogues?
gastritis
gallstones
give some examples of somatostatin analogues?
ocretide
sandostatin
lenreotide autogel
which dopamine agonist can be used in acromegaly?
cabergoline- up to 3g weekly
what kind of drig is pegvisomat?
GH antagonist
what is teh first line treatment for prolactinoma?
dopamine agonist
what condition is due to excess cortisol?
cushings syndrome
what occur in cushings sndromen due to protein loss?
myopathy
osteoperosis
thin skin
how can cushigns cause diabetes/obesity?
altered carbohydrate/lipid metabolism
excess mineralcorticoid causes what in cushings?
hypertension
oedema
cushings is characterised by?
thin skin
proximal myopathy
frontal balding in women
osteoperosis
why were people with cushings described as ‘lemon on matchsticks’ in previous years?
inc abdominal fat
thin legs due to muscle wasting
what dynamic test is used in cushings?
suppression test
why are random cortisol levels rearely useful in making a diagnosi of cushings?
cortisol levels vary to much normally anyway `
what supression test is used in diagnosing cushings?
overnoght 1mg dexamethasone
<50* nmol/l cortisol *normal
>100 nmol/l abnormal
what is the diference between cushings syndrome and cushings disease?
disease- cause ois pituitary
syndrome- all others
what are soem casues of cushings syndrome?
adenoma of adrenal
alcohol
steroids
what is an hypopituitarism?
pituitary isnt peoducing all its hormones
whta hornones does the anterior pituitary produce?
Growth Hormone
TSH
LH/FSH
ACTH
Prolactin
what are some casues of hypopituitarism?
pituitary tumours
local brain tumours
granulomatous diseases (TB, sarcoidosis)
trauma (RA, skull fracture)
what are some signs and symptoms of anterior hypopituitarism?
menstrual irregularities
infertilty
gynaecomastia
abdo obestity
loss of facial hair
dry skin/hair
what are some replacement therapies for hypopituitarism?
thyroxine
hydrocortisone
ADH
GH
sex steroids
