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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
follicuar thyroid carcinomas make up what percentage of thyroid cancers?
10%
26
how are follicualr thryoid carcinomas (FTC) usually treated?
lobectomy thyroidectomy if significant vascular invasion
27
thyroid lymphomas have a rapid onset in which pateint group?
femlaes aged 70-80
28
why do thyroid lymphomas affect elderly females mostly?
longstanding thyroxine treatment for autoimmune hypothyroidism
29
whcih condition is usually present in thryoid lymphoma?
autoimmune hypothyroidism
30
what procedure allows thyroid lymphomas to be diagnosed histologically?
core biopsy
31
following core biopsy of a thyroid lymphoma what is done for the patient?
steroids chemo radiotherapy
32
medullary thyroid carcicinoma is a tumour of which cells?
parafollicular cells
33
what is secreted by parafollicular cells that can be used as a tumour cell marker?
calcitonin
34
medullary thyroid carcinomas are common/rare
rare
35
the presence of what on FNA is used as diagnosis of medullary thyroid carcinoma?
amyloid calcitonin
36
what are the four types of medullary thyroid carcinoma?
sporadic familial non MEN familial MEN (MEN2a)
37
what should always be checked with medullary thyroid carcinomas?
24hr urinary metanephrines genetics
38
what tumour is highly associated with MTC?
**phaechromocytoma** secretes adrenaline
39
what two tests should be carried out to assess function and structure with a multinodular goitre?
TSH -function CT scan- structure
40
what is usually seen with TSH levels in multinodular goitre?
usually **normal or slightly suppressed**
41
what can CT scan show in a multinodular goitre?
retrosternal extension tracheal compression
42
what is done to treat a multinodular goitre?
most left alone RAI if sig hyperthyroid Surgery is structural issue
43
Differentiated thyroid cancer refers to which two variants?
papillary follicular
44
most DTCs take up _____ and secrete \_\_\_\_\_
take up **iodine** secrete **thyroglobulin**
45
DTCs are driven by which hormone?
TSH
46
DTCs have a better/poorer prognosis that other solid tumours?
better
47
which thyroid cancer type is the msot common?
papillary
48
how does papiallry thyroid cancer spread?
lympthatics
49
post op (lobectomy/thyroidectomy) what needs to be checked within 24hrs?
calcium levels
50
when is whole body iodine scanning used?
in patients who have undergone partial or total thyroidectomy **3-6 months post op**
51
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
52
what is thyroid remnant ablation (TRA)?
dose of radioiodine that destroys any remainign thyroid cells (potential cancer cells)
53
are people being treated with TRA allowed visitors?
yes- but have to sit further away and visit for less time
54
how long do people usually have to stay in hosptial for when recieving TRA?
usually 48hr stay
55
what percentage of the dose of TRA is excreted through the urrine within the first 24hrs?
80%
56
what cps value must patients exhibit in order to be discharged after TRA?
\<500cps | (counts per minute)
57
what is the longterm management of a patient after recieving TRA?
maintained on T4 suppress TSH levels
58
what is used as a 'tumour marker' after treatmetn with TRA?
thyroglobulin
59
TRA doubles the risk of which condition?
myeloid leukemia
60
has TRA been shown to cause infertility or genetic abnormalities in children?
**No**
61
what is the recurrence rate in thyroid cancers?
30%
62
what peripheral hormone pairs with ACTH?
cortisol
63
which peripheral hormone pairs with TSH?
thyroxine
64
which peripheral hormone pairs with LH/FSH?
testosterone
65
which peripheral hormone pairs with Growth hormone?
IGF-1
66
what is the only unpaired hormone?
prolactin
67
what released from the hypothalmus inhibits prolactin?
dopamine
68
in order of most to least common which direction is a pituitary tumour most likely to grow in?
superiorly laterally inferiorly
69
why is most common for a pituitary tumour to grow superiorly?
bony structures everywhere else
70
which structures can a laterally growing pituitary tumour interfere with?
cranial nerves in cavernous sinuses
71
what can happen if a pituitary tumour grows down the way?
enter sphenoid sinus and leaky sinus sinus fluid
72
what are dynamic tests?
tests that try to suppress/stimulate the hormone
73
which dynamic test is used when overproduction of a hormone is suspected?
suppression test
74
which dynamic test is used when underproduction of a hormone is suspected?
stimulation test
75
what is the name given to a pituitary tumour \<1cm?
**micro**adenoma
76
what is the name given to a pituitary tumour \>1cm?
**macro**adenoma
77
what is a non-functioning pituitary adenoma?
doesnt secrete anything
78
what are some casues of raised prolactin?
hypothyroidism breast feeding/pregnacy stress sleep dopamine antagonists e.g metoclopramide
79
who presents earlier with pituitary tumours? men/women
**women-** can present wth missed periods so noticed earlier
80
what are investigations used to investigate prolactinoma?
prolactin conc MRI pituitary visual fields (bitemporal hemianopia)
81
what is the treatment fro prolactinoma?
cabergoline (dostinex)
82
excess growth hormone causes which condition?
acromegaly
83
what are some common features of acromegaly?
sweaty large hands large jaw hypertension headaches diabetes snoring/sleep apnoea
84
what is used to diagnose acromegaly?
IGF1 GTT
85
what i steh treatment for acromegaly?
pituitary surgery external radiotherapy to pituitary fossa
86
what level of GH is staisfactory after treatment of acromegaly?
\<0.4ug/l
87
what level of GH requires drug therapy after treatment of acromegaly?
\>1ug/l
88
somatostatin anologues in acromegaly have been shown to decrese tumours by how much?
30-50% decrease in size
89
what are some of the short term side effects of somatostatin analogues?
flatulence diarrhoea abdo pain
90
what are some of the long term side effects of somatostatin analogues?
gastritis gallstones
91
give some examples of somatostatin analogues?
ocretide sandostatin lenreotide autogel
92
which dopamine agonist can be used in acromegaly?
**cabergoline**- up to 3g weekly
93
what kind of drig is pegvisomat?
GH antagonist
94
what is teh first line treatment for prolactinoma?
dopamine agonist
95
what condition is due to excess cortisol?
cushings syndrome
96
what occur in cushings sndromen due to protein loss?
myopathy osteoperosis thin skin
97
how can cushigns cause diabetes/obesity?
altered carbohydrate/lipid metabolism
98
excess mineralcorticoid causes what in cushings?
hypertension oedema
99
cushings is characterised by?
thin skin proximal myopathy frontal balding in women osteoperosis
100
why were people with cushings described as 'lemon on matchsticks' in previous years?
inc abdominal fat thin legs due to muscle wasting
101
what dynamic test is used in cushings?
**suppression** test
102
why are random cortisol levels rearely useful in making a diagnosi of cushings?
cortisol levels vary to much normally anyway `
103
what supression test is used in diagnosing cushings?
**overnoght 1mg dexamethasone** *_\<50*_ nmol/l cortisol _*normal_* *_\>100_* nmol/l *_abnormal_*
104
what is the diference between cushings syndrome and cushings disease?
disease- cause ois pituitary syndrome- all others
105
what are soem casues of cushings syndrome?
adenoma of adrenal alcohol steroids
106
what is an hypopituitarism?
pituitary isnt peoducing all its hormones
107
whta hornones does the anterior pituitary produce?
Growth Hormone TSH LH/FSH ACTH Prolactin
108
what are some casues of hypopituitarism?
pituitary tumours local brain tumours granulomatous diseases (TB, sarcoidosis) trauma (RA, skull fracture)
109
what are some signs and symptoms of anterior hypopituitarism?
menstrual irregularities infertilty gynaecomastia abdo obestity loss of facial hair dry skin/hair
110
what are some replacement therapies for **hypopituitarism?**
thyroxine hydrocortisone ADH GH sex steroids
111

03- Endocrine (9 decks)

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