Thyroid/Neck Lump

Question 1

What are some important questions of hx for thyroid a lump?

Answer 1

1. Cardinal features of lump
2. Thyroids symptoms - hypo/hyper
3. Regional symptoms of thyroid - Dysphagia, voice change, SOB
4. Risk factors - Head and neck radiation (lymphoma therapy, radiation exposure)
   - FHx

Question 2

What is important to palpate for with a thyroid lump?

Answer 2

Lump - smooth/irregular

• Mobile or tethered

LNs

Question 3

To which LN do thyroid cancers metastasize to?

Answer 3

Level 6 first - Can’t be felt

Then levels 2,3, and 4

Question 4

What is the next step when a the TFT find hyperthyroidism?

Answer 4

Nuclear uptake scan

Question 5

What is the prefered investigation for a thyroid lump, FNA or core biopsy?

Answer 5

FNA

Question 6

When do you biopsy a lump?

Answer 6

>1cm and solid

>1.5cm and mixed

Other concerning hx or US findings

Question 7

When do you CT in thyroid lumps?

Answer 7

If there is retrosternal extension

Question 9

What are the six outcomes of FNA? And their risks of cancer? What do you do?

Answer 9

Inadequate: 1-5%: Repeat

Benign: 5%: Screen in 12months

AUS (atypica of unknown significance): 5-10%: ReUS and FNA in 6months

Follicular/Hurthle neoplasm:

Highly suspicious: 70-90%

Cancer: >95

Question 10

What are the 5 types of thyroid cancer?

Answer 10

Papillary

Follicular

Medullary

Anaplastic

Lymphoma

Question 11

How do you differentiate a follicular adenoma and carcinoma?

Answer 11

Carcinoma has:

• Capsular invasion
• Vascular invasion

Question 12

For what type of thyroid cancer is an FNA inadequate for diagnosis?

Answer 12

Follicular

Question 13

How is thyroid cancer treated?

Answer 13

Surgery

Radiative iodine

Thyroxine (to negatively feedback on TSH production)

Question 14

What are some DDx for a neck lump?

Answer 14

Thyroid

LN

Abscess

Cysts - thyroglossal, brachial cleft

Salivary gland tumour

Mets

Virchow’s node