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Endocrine: The Thyroid > Thyroid Neoplasms > Flashcards

Thyroid Neoplasms Flashcards

1
Q

benign causes of nodules

A

cyst
colloid nodule
benign follicular adenoma
hyperplastic nodules

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2
Q

malignant causes of nodules

A 
papillary
follicular
medullary
lymphoma
poor differentiated (anaplastic)
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3
Q

how to check whether a nodule is on the thyroid?

A

check it moves on swallowing as the thyroid is invested in the pre-tracheal fascia

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4
Q

what is an uncommon feature in a nodule?

A

pain but can be caused by an intra-thyroidal bleed into a cyst

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5
Q

diagnosis of neoplasm

A
  • history: neck irradiation and FH of thyroid carcinoma
  • examination: neck nodes and hoarseness
  • investigation: TSH and USS-FNA for cytology or core biopsy for morphology (lymphoma)
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6
Q

what investigations are not used in neoplasms

A

isotope thyroid scan

CT/MRI

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7
Q

USS-FNA classification

A 
thy1= inadequate sample
thy2/U2= bengin
thy3/U3= atypical
thy4/U4= probably malignant
thy5/U5= malignant
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8
Q

staging that can be used?

A

TNM

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9
Q

low risk thyroid tumours

A

under 50

tumour <4cm

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10
Q

follow-up for low risk nodules

A

TSH and thyroglobulin measured every 6 months for first 5 years, then annually for next 5

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11
Q

predictors of malignancy

A
  • new thyroid nodule age <20 or >50
  • lesion >4cm in diameter and size increasing
  • male
  • history of head and neck radiation
  • vocal cord palsy
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12
Q

define adenoma

A

this is a benign discrete solitary mass that is often an incidental finding, but if large can cause local symptoms

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13
Q

what is an adenoma comprised of?

A

neoplastic thyroid follicles (follicular adenoma)

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14
Q

what is an adenoma difficult to distinguish from?

A

nodule in goitre

follicular carcinoma

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15
Q

what do some adenomas do?

A

secrete thyroid hormones causing thyrotoxicosis, due to mutation in TSHR signalling pathway that activates G proteins and cAMP

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16
Q

what age groups is thyroid carcinoma more common in?

A

females 15-40
males more common with age
uncommon in children

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17
Q

causes of carcinomas

A

environment

genetics

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18
Q

which carcinoma is associated with radiation

A

papillary

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19
Q

which carcinoma is associated with iodine deficiency

A

follicular

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20
Q

what are differentiated thyroid cancers driven by?

A

TSH

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21
Q

which is the most common carcinoma?

A

papillary

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22
Q

presentation of papillary carcinoma?

A

usually a solitary nodule
lymph node metastasis common
haematogenous spread rare, but usually to lung
associated with Hashimoto’s thyroiditis

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23
Q

survival rates from papillary carcinoma

24
Q

buzzword for pathology of papillary carcinoma

A

orphan Annie eye nuclei psammoma bodies

25
who is follicular carcinoma most common in?
females 40-50s (older than papillary)
26
presentation of follicular carcinoma
slow growing painless non-functional nodule haematogenous spread to bone, lungs and liver lymph node spread rare invasive growth pattern of vasculature/capsle
27
management of follicular carcinoma
thyroid lobectomy, but if significant invasion then total thyroidectomy
28
where are incident rates higher for follicular carcinoma?
regions of iodine deficiency
29
what is medullary thyroid carcinoma derived from?
C cells so can secrete calcitonin
30
what can MTC be associated with?
MEN2a/b | amyloid deposition of abnormally folded calcitonin
31
presentation of MTC
neck mass | paraneoplastic syndrome e.g. diarrhoea (VIP production) and Cushing's (ACTH production
32
management of MTC
total thyroidectomy
33
describe anaplastic carcinoma
undifferentiated, aggressive tumours | rapid growth and involvement of neck structures
34
who does anaplastic carcinomas present in?
older patients usually
35
five types of thyroid carcinoma
``` papillary carcinoma follicular carcinoma medullary thyroid carcinoma anaplastic carcinoma lymphoma ```
36
risk associations with lymphoma
background of AI hypothyroidism on T4
37
presentation of lymphoma
rapid onset mass | usually women 70-80
38
diagnosis of lymphoma
core biopsy
39
management of lymphoma
R-CHOP chemo radio steroids
40
management of DTC
surgery is first line, options include: - thyroid lobectomy with isthmusectomy - sub-total thyroidectomy - total thyroidectomy
41
risk stratification post-op
``` AMES age metastasis extent of primary size of primary tumour ```
42
AMES low risk
- younger patients (men <40 and women <50) with no metastasis -older patients with minimally invasive lesion, tumour <5cm add no distant metastasis
43
management of AMES low risk
thyroid lobectomy with isthmusectomy
44
AMES high risk
all patients with distant metastases extrathyroidal disease in patients with papillary cancer significant capsular invasion with follicular carcinoma primary tumour >5cm in old patients
45
when sub-total or total thyroidectomy used in DTC?
``` extra-thyroidal spread bilateral/multifocal DTC DTC with distant metastasis nodal involvement AMES high risk ```
46
lymph node surgery
central lymph node clearance
47
post-op care
check calcium and give replacement if below 2mmol/L | discharge on T3/4
48
when is whole body iodine scanning used
patients who have undergone sub-total or total thyroidectomy usually 3-6 months post-op
49
what happens to medications before the scan?
T4 stopped 4 weeks prior to the scan T3 stopped 2 weeks prior to the scan rhTSH is better as no need to stop T3/T4
50
what level should TSH be for best results in total body iodine scanning
more than 20
51
lead up to whole body iodine scanning
rhTSH injections Monday/Tuesday and mCi capsule on Wednesday and patients return for imaging on Friday results of scan inform treatment decision
52
describe thyroid remnant ablation
- admitted to a lead-lined room with mains sewerage - pre-treated with rhTSH - 2 or 3 GBq capsule of I-131 administered
53
side effects of thyroid remnant ablation
sialadenitis sore throat use disposable cutlery and no contact until no longer radioactive discharge when count rate <500cps at 1m (Geiger counter) and post-therapy scan prior to discharge patients maintained on T4 (below 25)
54
recurrent disease
- detected clinically through rising Tg or by imaging - recurrence in cervical lymph nodes is often papillary - haematogenous spread to lungs, bone or brain more common in follicular - patients undergo whole body scan to determine ability of disease to take up iodine (difficult if this is negative) - PET
55
systemic anti-cancer therapy (SACT)
- sorafenib and lenvatinib for patients DTC refractory to radioactive iodine therapy

Endocrine: The Thyroid (15 decks)

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