Thyroid nodule Flashcards

1
Q

typical nodule/CA sx

A
  • incidental of physical
  • pt finds it
  • pt has nech SX
  • Fam Hx of thyroid CA
  • Hx of irradiation
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2
Q

DDx for thyroid mass

A
solitary 
- cyst
- thryoid adenoma
- CA
multiple
- multinodular goiter
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3
Q

2 investigations of thyroid mass

A
  1. TSH

2. US

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4
Q

rule for biopsies

A

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

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5
Q

when is biopsy not necc (3)

A

1.

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6
Q

3 steps to assessment of nodule

A
  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
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7
Q

2 imaging and indications

A
  1. US - best for viewing

2. radioisotope - only if TSH low

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8
Q

what is HOT nodule

A
  • overproducing
  • looks black
  • TSH low so rest of gland looks white
  • ZERO CA risk
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9
Q

what is cold nodule

A
  • won’t take up radioscan
  • TSH usually normal
  • 5-15% chance of malig. in cold
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10
Q

see flowchart on evaluation

A

you;ll like it, it’s pretty

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11
Q

3 roles of pathologist

A
  1. decide the nodules that need surgery (FNA)
  2. determine biological nature of the nodule
  3. provide prognosticators
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12
Q

what it “thyroid nodule”

A

descriptive terminaology, not a pathobiological entitiy

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13
Q

2 common non-neoplastic possibilities

A
  1. MNG

2. hashimotos

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14
Q

2 common neoplasitic possibilities

A

malignant - papillary thyroif carcinoma

benign - follicular adenoma

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15
Q

2 diagnositc features of thyroid carcinoma

A
  1. nuclear features of PTC

2. invasive growth - CANNOT be assessed on FNA samples

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16
Q

2 purposes of FNA

A

1, provide rational approach for mgmt

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

17
Q

5 types of bethesthda

A
  1. benign
  2. atypia/follicular lesiokn of unknown sig.
  3. follicular neoplasm
  4. suspicious for malig.
  5. malig
18
Q

etiologies of thyroid CA

A
  1. external radiation in early life (MAJOR)
  2. fam hx
  3. high dietary iodine
  4. obesity/insulin resitnace
19
Q

what are 3 CA from follicular thyroid cells

A
  1. well diff. thy carcinoma
    - papilllary thyroid carcinoma (95%)
    - follicular thyroid carcinoma
  2. poorly diff. thyroid CA
  3. anaplastic thyroid CA
20
Q

what is main CA from parafollicular C cells

A

medually thyroid carcinoma

21
Q

what is pap TC

A
  • most common endocrine malig

- most indolent human CA

22
Q

what is follicular TC

A
  • in vasice growth but no PTC nuclei

- distant mets. common

23
Q

what is poorly diff. TC

A
  • aggresive
  • solitary large thyroid mass
  • distant and nodale mets. common at presentation
24
Q

what is anaplastic TC

A
  • one of most aggressive CA
  • p53 mutation
  • large masses with obastruciton
25
what is meduallry TC
derived from parafoll C-cells | - prog. worse that PTC or FTC
26
what is treatment of TC
- surgery - radioactive iodine - follow up with L-thyroine to supress TSH
27
8 features of nodule that suggest malig.
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
28
CAs in increasing risk
1. papillary 2. follicular 3. meduallry 4. anaplastic