Thyroid Neoplasms

Question 1

three step diagnosis of thyroid neoplasms

Answer 1

1. history= neck irradiation and FH of thyroid carcinoma
2. examination= neck nodes and hoarseness
3. investigation= TSH and USS-FNA for cytology and core biopsy for morphology (lymphoma)

Question 2

predictors of malignancy

Answer 2

<20 or >50
>4cm
male
history of head and neck radiation
vocal cord palsy

Question 3

what is follicular adenoma?

Answer 3

benign mass that is difficult to distinguish from a nodule in goitre or follicular carcinoma

Question 4

five carcinomas of the thyroid

Answer 4

1. papillary carcinoma
2. follicular carcinoma
3. medullary thyroid carcinoma
4. anaplastic
5. lymphoma

Question 5

what is the most common thyroid cancer?

Answer 5

papillary carcinoma

Question 6

associations with papillary carcinoma

Answer 6

lymph node metastasis
associated with Hasimoto’s thyroiditis
radiation

Question 7

who has older presentation - papillary or follicular carcinoma?

Answer 7

follicular carcinoma

Question 8

associations with follicular carcinoma

Answer 8

haematogenous metastasis

iodine deficiency

Question 9

where does medullary thyroid carcinoma arise?

Answer 9

derived from C cells so can secrete calcitonin

Question 10

what is MTC associated with?

Answer 10

MEN2a/b

amyloid deposition

Question 11

anaplastic carcinoma associations

Answer 11

undifferentiated
aggressive
older patients

Question 12

lymphoma associations

Answer 12

AI hypothyroidism

Question 13

who is lymphoma seen in?

Answer 13

women 70-80

Question 14

diagnosis of lymphoma

Answer 14

core biopsy

Question 15

management of thyroid carcinoma

Answer 15

surgery is first line

Question 16

surgical options for thyroid carcinoma

Answer 16

thyroid lobectomy
sub-total thyroidectomy
total thyroidectomy

may also need lymph node surgery

thyroid remanent ablation (I-131)
systemic anti-cancer therapy SACT e.g. sorafenib and lenvatinib

Question 17

risk stratification post-op

Answer 17

AMES

age
metastasis
extent of primary
size of primary

Question 18

who should have whole body iodine scanning

Answer 18

patients who have undergone sub-total or total thyroidectomy