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Year 2 Endocrine > Thyroid nodular management > Flashcards

Thyroid nodular management Flashcards

1
Q

Causes of benign thyroid nodule

A

Cyst
Colliod nodule
Benign follicular adenoma
Hyperplastic nodule

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2
Q

In a benign thyroid nodule what could result in pain?

A

A intra thyroid bleed into a cyst

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3
Q

What is the first line test after clinical examination and bloods?

A

USS-FNA

Ultra sound with fine needle aspiration

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4
Q

USS-FNA

Thy 1

A

Inadequate

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5
Q

USS-FNA

Thy 2

A

Benign

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6
Q

USS-FNA

Thy 3

A

Atypical

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7
Q

USS-FNA

Thy 4

A

Probably malignant

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8
Q

USS-FNA

Thy 5

A

Malignant

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9
Q

What signifies a low risk patient?

A

Aged <50
Tumour <4cm
Baseline Thyroglobulin
TSH lower range of normal

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10
Q

In a low risk patient what is the treatment

A

Lobectomy

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11
Q

What signifies a high risk patient?

A

TSH < 1mU/L

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12
Q

In a high risk patient what is the treatment

A

Total thyroidectomy

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13
Q

T1

A

Tumour under <2cm

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14
Q

T2

A

Tumour under 4cm but > 2 cm

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15
Q

T3

A

Tumour greater than 4cm but limited to thyroid and immediate tissue within thyroid capsule

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16
Q

What tissues could be invaded whilst still classified as T3

A

Sternothyroid muscle

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17
Q

T4a

A

Moderately advanced tumour

Any size of tumour extending beyond thyroid capsule invading any soft tissue

18
Q

T4b

A

Very advanced tumour
Invades prevertebral fascia
Encases carotid artery or mediastinal vessels

19
Q

N0

A

No regional lymph metastasis

20
Q

N1

A

Regional lymph metastasis

21
Q

N1a

A

Metastasis to level VI pre/para tracheal lymphnodes

22
Q

N1b

A

Metastasis to Uni/Bi/Contra lateral lymph

Cervical, retropharyngeal and superior mediastinal also affected

23
Q

M0

A

No distant metastasis

24
Q

M1

A

Distant metastasis

25
Q

What signifies a high risk group once cancer diagnosed?

A

T3 or higher

26
Q

Treatment for high risk cancer group?

A

Total thyroidectomy

Consider radioactive iodine

27
Q

What is RAI treatment

A

Radioactive iodine isotopes are taken up by the thyroid from where the isotope kill thyroid cells

28
Q

Follow up in papillary and follicular cancer

A

TSH and thyroglobulin blood tests every 6 months for 5 years then annually for 5 more.

29
Q

What can be used as a tumour cell marker in thyroid cancer?

A

Thyroglobulin

30
Q

What monitored levels of TSH are desirable post treatment?

A

0.4-4 mU/L

31
Q

Thyroid lymphoma

A

Background of autoimmune hypothyroidism
Rapid growth in thyroid
Women aged 70-80

32
Q

What is used for diagnosis in thyroid lymphoma

A

Core biopsy

33
Q

Treatment in thyroid lymphoma

A

Chemotherapy
Deep X ray therapy
Steroids

34
Q

What is the chemotherapy agent used in thyroid lymphoma ?

A

R-CHOP

35
Q

What types of medullary thyroid cancer are there?

A

Sporadic
Familial non MEN
Familia MEN2a(B)

36
Q

What treatment should be considered if familial history on MEN2a(B)

A

Prophylactic thyroidectomy as a child

37
Q

In a multi nodular thyroid goitre what two things should be assessed?

A

Function- TSH and Thyroglobulin

Structure - CT scan

38
Q

Treatment in multinodular goitre

A

Most leave alone
Radioactive Iodine if hyperthyroidism
Surgery is structural issue

39
Q

When is surgery indicated in multinodular goitre?

A 
Lifestyle interference
Possibility of cancer
Tracheal compress <7mm if symptomatic
Audible stridor
Other respiratory issues
40
Q

Why is Fine needle aspiration not helpful for diagnosing follicular carcinoma

A

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

41
Q

What can be used as a tumour marker in medullary thyroid cancer?

A

Calcitonin

MTC is cancerous C-Cells

Year 2 Endocrine (21 decks)

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