Thyroid Neoplasms - SRS

Question 1

What is this most often caused by?

Answer 1

Enlargement of the thyroid, or goiter is caused by impaired synthesis of thyroid hormone, which is most often the result of dietary iodine deficiency

Question 2

Diffuse nontoxic (simple) goiter causes enlargement of the entire gland without?

Answer 2

producing nodularity

Question 3

Endemic goiter occurs in geographic areas where the soil, water, and food supply contain low levels of iodine. The ingestion of substances that interfere with thyroid hormone synthesis at some level, such as some vegetables have been shown to be goitrogenic. What are some examples?

Answer 3

1. Cabbage
2. Cauliflower
3. Brussel Sprouts
4. Turnips
5. Cassava

Question 4

What are the two types of diffuse nontoxic goiter?

Answer 4

Endemic goiter

Sporadic goiter

Question 5

Sporadic goiter occurs less frequently than does endemic goiter. What is the typical population/age that this hits?

Answer 5

There is a striking female preponderance and a peak incidence at puberty or in young adult life.

Question 6

What would this person’s thyroid output probably be like?

Euthyroid, hypothyroid, hyperthyroid?

Answer 6

Euthyroid

Question 7

Shown below are the two phases that can be identified in the evolution of a diffuse nontoxic goiter. Identify them.

Answer 7

Left: Hyperplastic phase

Right: Colloid Involution

Question 8

What is this?

What lead to its development?

Answer 8

Recurrent episodes of hyperplasia and involution combined to produce irregular enlargement, leading to this… a multinodular goiter.

Question 9

The dominant clinical features of multinodular goiter are those caused by mass effects.

What are some examples of these sorts of mass effects seen in a multinodular goiter setting?

Answer 9

1. Superior Vena cava Syndrome
2. Compression of large neck vessels
3. Airway Obstruction
4. Dysphagia
5. Ugliness

Question 10

What is plummer syndrome?

What does plummer syndrome specifically not present with?

Answer 10

When an autonomous nodule arises in a long standing goiter and produces hyperthyroidism - toxic multinodular goiter.

Not accompanied by the infiltrative ophthalmopathy and dermopathy of Graves disease.

Question 11

What is the ratio of benign thyroid neoplasms to thyroid carcinomas?

Answer 11

10:1

Question 12

What are five possible characteristic criteria that indicate a thyroid mass is more likely malignant?

Answer 12

1. Solitary nodules
2. Nodules in young patients
3. Nodules in males
4. Nodules in a patient with a history of radiation to the head and neck
5. Cold nodules (non-functional)

Question 13

What is revealed in the attached uptake scan and fusion scans?

What does this indicate about the malignant potential?

Answer 13

Cold nodule - more likely malignant

Question 14

Adenomas of the thyroid are typically discrete, solitary masses, derived from follicular epithelium, and hence they are also known as?

Answer 14

follicular adenomas.

Question 15

Is hormone production in a toxic adenoma dependent upon TSH?

Answer 15

No

Question 16

What histologic features must be used to distinguish a follicular adenoma from a follicular carcinoma?

Answer 16

Must evaluate capsular integrity to determine if invasive.

Assess if vascular invasion has occurred.

Question 17

How would you describe the thyroid adenoma shown here?

Is this malignant?

Answer 17

Hurthle cell adenoma

Not necessarily malignant but could be.

Question 18

Below are the four major subtypes of papillary carcinomas and their relative frequencies. Identify the age range for each subtype.

1. Papillary carcinoma (>85% of cases)
2. Follicular carcinoma (5% to 15% of cases)
3. Anaplastic (undifferentiated) carcinoma (<5% of cases)
4. Medullary carcinoma (5% of cases)

Answer 18

Papillary carcinoma (>85% of cases): 20 - 40 yrs

Follicular carcinoma (5% to 15% of cases): 40 - 60 yrs

Anaplastic (undifferentiated) carcinoma (<5% of cases): 60 - 80 yrs

Medullary carcinoma (5% of cases): age range not specified

Question 19

What is most commonly mutated in a papillary carcinoma of the thyroid?

Answer 19

RET

Question 20

What is the most common mutation in follicular carcinoma of the thyroid?

Answer 20

RAS

Question 21

Generally speaking, what pathways are the gene alterations in the pathogenesis of thyroid carcinoma?

Answer 21

Growth factor receptor signaling pathways

Question 22

What are the two major environmental risk factors for thyroid carcinoma?

Answer 22

Ionizing radiation, especially in the first two decades of life.

Deficiency of dietary iodine

Question 23

What type of thyroid carcinoma does ionizing radiation tend to push one towards?

Answer 23

Papillary carcinoma

Question 24

What type of thyroid carcinoma does a diet deficient in iodine push one towards?

Answer 24

Follicular carcinoma

Question 25

If a thyroid neoplasm is described as gray/white, what should you think of?

Answer 25

Papillary carcinoma

Question 26

What is this nodule that was reseted from a patients lower right thyroid lobe?

Answer 26

Papillary carcinoma

Question 27

What type of thyroid tumor was this taken from? How can you tell?

Answer 27

Papillary Carcinoma: Optical clearing in the cells (orphan annie eyes).