Thyroid nodule

Question 1

typical nodule/CA sx

Answer 1

• incidental of physical
• pt finds it
• pt has nech SX
• Fam Hx of thyroid CA
• Hx of irradiation

Question 2

DDx for thyroid mass

Answer 2

solitary 
- cyst
- thryoid adenoma
- CA
multiple
- multinodular goiter

Question 3

2 investigations of thyroid mass

Answer 3

1. TSH

2. US

Question 4

rule for biopsies

Answer 4

any solid nodule over 1cm needs to be biopsied unless hot

Question 5

when is biopsy not necc (3)

Answer 5

1.

Question 6

3 steps to assessment of nodule

Answer 6

1. assess CA risk
   - fam Hx, radition, large and growing rpidly
2. check TSH
   - if normal go to step 3
   - if supressed, do scan (if hot treat, if cold do step 3)
3. ultrasound and FNA biopsy

Question 7

2 imaging and indications

Answer 7

1. US - best for viewing

2. radioisotope - only if TSH low

Question 8

what is HOT nodule

Answer 8

• overproducing
• looks black
• TSH low so rest of gland looks white
• ZERO CA risk

Question 9

what is cold nodule

Answer 9

• won’t take up radioscan
• TSH usually normal
• 5-15% chance of malig. in cold

Question 10

see flowchart on evaluation

Answer 10

you;ll like it, it’s pretty

Question 11

3 roles of pathologist

Answer 11

1. decide the nodules that need surgery (FNA)
2. determine biological nature of the nodule
3. provide prognosticators

Question 12

what it “thyroid nodule”

Answer 12

descriptive terminaology, not a pathobiological entitiy

Question 13

2 common non-neoplastic possibilities

Answer 13

1. MNG

2. hashimotos

Question 14

2 common neoplasitic possibilities

Answer 14

malignant - papillary thyroif carcinoma

benign - follicular adenoma

Question 15

2 diagnositc features of thyroid carcinoma

Answer 15

1. nuclear features of PTC

2. invasive growth - CANNOT be assessed on FNA samples

Question 16

2 purposes of FNA

Answer 16

1, provide rational approach for mgmt

2. good for assessment of details, but not for invasive growth

Question 17

5 types of bethesthda

Answer 17

1. benign
2. atypia/follicular lesiokn of unknown sig.
3. follicular neoplasm
4. suspicious for malig.
5. malig

Question 18

etiologies of thyroid CA

Answer 18

1. external radiation in early life (MAJOR)
2. fam hx
3. high dietary iodine
4. obesity/insulin resitnace

Question 19

what are 3 CA from follicular thyroid cells

Answer 19

1. well diff. thy carcinoma
   - papilllary thyroid carcinoma (95%)
   - follicular thyroid carcinoma
2. poorly diff. thyroid CA
3. anaplastic thyroid CA

Question 20

what is main CA from parafollicular C cells

Answer 20

medually thyroid carcinoma

Question 21

what is pap TC

Answer 21

• most common endocrine malig

- most indolent human CA

Question 22

what is follicular TC

Answer 22

• in vasice growth but no PTC nuclei

- distant mets. common

Question 23

what is poorly diff. TC

Answer 23

• aggresive
• solitary large thyroid mass
• distant and nodale mets. common at presentation

Question 24

what is anaplastic TC

Answer 24

• one of most aggressive CA
• p53 mutation
• large masses with obastruciton

Question 25

what is meduallry TC

Answer 25

derived from parafoll C-cells

- prog. worse that PTC or FTC

Question 26

what is treatment of TC

Answer 26

• surgery
• radioactive iodine
• follow up with L-thyroine to supress TSH

Question 27

8 features of nodule that suggest malig.

Answer 27

1. fixed and moves with swallowing
2. firm and irreg.
3. solitary
4. Hx of Rads
5. rapid dev.
6. vocal cord paralysis
7. cervical adenopathy
8. elevated serum calcitonin

Question 28

CAs in increasing risk

Answer 28

1. papillary
2. follicular
3. meduallry
4. anaplastic