Thyroid nodular management Flashcards
Causes of benign thyroid nodule
Cyst
Colliod nodule
Benign follicular adenoma
Hyperplastic nodule
In a benign thyroid nodule what could result in pain?
A intra thyroid bleed into a cyst
What is the first line test after clinical examination and bloods?
USS-FNA
Ultra sound with fine needle aspiration
USS-FNA
Thy 1
Inadequate
USS-FNA
Thy 2
Benign
USS-FNA
Thy 3
Atypical
USS-FNA
Thy 4
Probably malignant
USS-FNA
Thy 5
Malignant
What signifies a low risk patient?
Aged <50
Tumour <4cm
Baseline Thyroglobulin
TSH lower range of normal
In a low risk patient what is the treatment
Lobectomy
What signifies a high risk patient?
TSH < 1mU/L
In a high risk patient what is the treatment
Total thyroidectomy
T1
Tumour under <2cm
T2
Tumour under 4cm but > 2 cm
T3
Tumour greater than 4cm but limited to thyroid and immediate tissue within thyroid capsule
What tissues could be invaded whilst still classified as T3
Sternothyroid muscle
T4a
Moderately advanced tumour
Any size of tumour extending beyond thyroid capsule invading any soft tissue
T4b
Very advanced tumour
Invades prevertebral fascia
Encases carotid artery or mediastinal vessels
N0
No regional lymph metastasis
N1
Regional lymph metastasis
N1a
Metastasis to level VI pre/para tracheal lymphnodes
N1b
Metastasis to Uni/Bi/Contra lateral lymph
Cervical, retropharyngeal and superior mediastinal also affected
M0
No distant metastasis
M1
Distant metastasis
What signifies a high risk group once cancer diagnosed?
T3 or higher
Treatment for high risk cancer group?
Total thyroidectomy
Consider radioactive iodine
What is RAI treatment
Radioactive iodine isotopes are taken up by the thyroid from where the isotope kill thyroid cells
Follow up in papillary and follicular cancer
TSH and thyroglobulin blood tests every 6 months for 5 years then annually for 5 more.
What can be used as a tumour cell marker in thyroid cancer?
Thyroglobulin
What monitored levels of TSH are desirable post treatment?
0.4-4 mU/L
Thyroid lymphoma
Background of autoimmune hypothyroidism
Rapid growth in thyroid
Women aged 70-80
What is used for diagnosis in thyroid lymphoma
Core biopsy
Treatment in thyroid lymphoma
Chemotherapy
Deep X ray therapy
Steroids
What is the chemotherapy agent used in thyroid lymphoma ?
R-CHOP
What types of medullary thyroid cancer are there?
Sporadic
Familial non MEN
Familia MEN2a(B)
What treatment should be considered if familial history on MEN2a(B)
Prophylactic thyroidectomy as a child
In a multi nodular thyroid goitre what two things should be assessed?
Function- TSH and Thyroglobulin
Structure - CT scan
Treatment in multinodular goitre
Most leave alone
Radioactive Iodine if hyperthyroidism
Surgery is structural issue
When is surgery indicated in multinodular goitre?
Lifestyle interference Possibility of cancer Tracheal compress <7mm if symptomatic Audible stridor Other respiratory issues
Why is Fine needle aspiration not helpful for diagnosing follicular carcinoma
As unable to indicate whether the capsule has been broken, so distinguishing if its minimally or widely invasive.
The two have different treatment strategies and prognosis
What can be used as a tumour marker in medullary thyroid cancer?
Calcitonin
MTC is cancerous C-Cells
