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Endocrine-Week 1/2 > Thyroid Nodule & Cancer > Flashcards

Thyroid Nodule & Cancer Flashcards

1
Q

A lump that is below cricoid and LATERAL to midline neck that moves with SWALLOWING is most likely a…

A

Thyroid nodule

*most are thyroid adenomas and small percent are thyroid cancers.

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2
Q

A lump that is in midline and protrudes when tongue is stuck out is

A

Thyroglossal duct cyst

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3
Q

Thyroid ______ is caused by focal intrinsic activation

A

tumor/neoplasm

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4
Q

Thyroid ______ is caused by focal extrinsic activation

A

hyperplasia

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5
Q

Why is the incidence of Thyroid Nodules increasing?

A

Due to widespread use of sensitive imaging techniques

*usually for Non-thyroid concerns so thyroid nodules are mostly found incidentally

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6
Q

Only about ____% of Thyroid nodules are cancerous and hyperfunctioning

A

5

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7
Q

What are historical risk factors for malignancy?

A
  1. Radiation exposure (papillary thyroid cancer)
  2. Family Hx (MEN2a or FAP)
  3. Demographics (<20 or >60 of age; male)
  4. Compressive symptoms (hoarseness, dysphagia, and dysphonia)
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8
Q

What characteristics of a Thyroid nodule make you worried that it is malignant?

A

Large (>3cm)
Firm
Fixed
Cervical/supraclavicular lymphadenopathy

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9
Q

What are the steps in evaluating thyroid nodules after appropriate history and physical?

  • For normal TSH (most likely)
A
  1. Check TSH
  2. FNA with U/S guidance (nodules >1 cm)
  3. Determine malignancy
    - Benign (60-70%)
    - Indeterminate (20-30%)
    - Malignant (5%)
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10
Q

For benign thyroid nodule, what is the treatment?

A

Observation in most cases

  • monitor periodically with exam +/- U/S
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11
Q

For indeterminate thyroid nodule, what is the treatment?

A

Repeat FNA, molecular testing, or diagnostic surgery

  • Usually indeterminate thyroid nodules are atypia, follicular lesion, or follicular neoplasm
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12
Q

For malignant thyroid nodule, what is the treatment?

A

surgery (partial or total thyroidectomy)

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13
Q

What are the steps in evaluating thyroid nodules after appropriate history and physical?

  • For low TSH (occasionally ~5%)
A
  1. Check TSH

2. Determine if nodule is hyperfunctioning

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14
Q

When would you want to perform a Radioiodine scan instead of a fine needle aspiration for a Thyroid nodule

A

If TSH is LOW (thus hyperfunctioning, with VERY LOW likelihood of malignancy, so no aspiration needed)

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15
Q

Most nodules appear _____ on radioiodine scans

A

Cold

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16
Q

Hyperfunctioning nodules appear _____ on radioiodine scans

A

Hot

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17
Q

Best diagnostic procedure for a COLD thyroid nodule

A

Fine needle aspiration and cytology

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18
Q

Benign thyroid neoplasms are

  • most abundant type of thyroid neoplasms
A

follicular adenoma

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19
Q

Malignant thyroid neoplasms from follicular cells

A 
Papillary carcinoma (85%)
Follicular Carcinoma (10%)
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20
Q

Malignant thyroid neoplasms from parafollicular/C-cells

A 
Medullary Carcinoma (3%)
Anaplastic Carcinoma (1%)
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21
Q

Most thyroid neoplasms OVERALL are (papillary/follicular)

A

Follicular

22
Q

MALIGNANT Thyroid neoplasms are usually (papillary/follicular)

23
Q

MALIGNANT thyroid neoplasm; 85% of all thyroid malignancies; more common in FEMALES; EXCELLENT prognosis; regional lymph node invasion/metastases are COMMON (>50%); distant blood borne metastases are UNCOMMON

A

Papillary Thyroid Carcinoma

24
Q

Papillary Thyroid Carcinoma likes to spread via (lymph/blood)

25
MALIGNANT thyroid neoplasm; more common in females; peak incidence in 40's to 60's; prognosis varies between encapsulated (excellent) and widely invasive (poor); tumor spreads by BLOOD BORN metastases; distant spread overall more common than in PTC.
Follicular Thyroid Carcinoma
26
Follicular Thyroid Carcinoma likes to spread via (lymph/blood)
blood
27
Most common sites of Follicular Thyroid Carcinoma blood born metastases are
lung and bone
28
Treatment for PTC and FTC
Surgery--> Radioiodine Tx & high dose thyroid hormone replacement to keep TSH low
29
Recurrence of PTC and FTC are monitored by
- Thyroglobulin - Neck U/S - Whole Body Iodine Scans
30
MALIGNANT thyroid neoplasm (~3%); arise from Parafollicular cells ("C"-cells); has a neuroendocrine appearance with round/oval and spindle-shaped cells; SPORADIC (80%) or FAMILIAL (20%); and prognosis is based on degree of invasion (worse with distant site spread)
Medullary Thyroid Carcinoma
31
Histologic findings for Medullary Thyroid Carcinoma
Neuroendocrine appearance with packets of round, oval, and spindle-shaped cells; Stroma filled with "Amyloid"
32
Treatment for MTC
Surgery --> thyroid hormone replacement to maintain NORMAL TSH level
33
Recurrence of MTC is monitored by
Calcitonin and Neck U/S
34
________ inhibitors are approved for metastatic or refractory MTC
tyrosine kinase inhibitors
35
LEAST common (~1%) of the MALIGNANT thyroid neoplasm but most deadly; peak incidence in 60-80s; more common in MALES; prognosis is VERY POOR; metastasis are COMMON but usually strangles patient with local infiltration of VITAL structures in the neck
Anaplastic Thyroid Carcinoma
36
Treatment for ATC
usually inoperable so focus should be on palliative care
37
Thyroid enlargement
Goiter
38
Non-toxic goiter is aka
Euthyroid or Hypothyroid
39
Toxic goiter is aka
Hyperthyroid
40
Non-toxic goiter due to intra-thyroid nodules is
non-toxic multinodular goiter
41
Non-toxic goiter due to diffuse thyroid enlargement is caused by
Iodine deficiency Goitrogens Chronic Lymphocytic Thyroiditis (Hashimoto's)
42
Toxic goiter due to intra-thyroid nodules is
Toxic multinodular goiter (more common) | Toxic uninodular goiter
43
Toxic goiter due to diffuse thyroid enlargement is caused by
Diffuse Toxic Goiter (Grave's disease)
44
Most common cause of Goiters worldwide
Iodine-deficiency (Endemic goiter)
45
Type of Goiter; asymmetric or irregular gland; multiple nodules showing areas of both increased and decreased uptake ("patchy"); increases with age; thyroid function tests are normal or mildly low; may develop hyperthyroidism over time if untreated
Non-Toxic Multinodular Goiter
46
Multinodular goiter is (toxic/nontoxic) if TSH is normal
Non-toxic
47
Multinodular goiter is (toxic/nontoxic) if TSH is low
Toxic
48
Treatment for Multinodular goiter
1. Surgery if with compressive symptoms 2. Radioiodine ablation/surgery if nodules cause hyperthyroidism 3. Just observation if no symptoms, normal TSH, and no concern for cancer
49
What are compressive symptoms?
Choking, dysphagia, hoarseness, facial edema, and dyspnea
50
What sign is used to evaluate venous obstruction in patients with goiters?
Pemberton's Sign
51
Pemberton's Sign is POSITIVE when
bilateral arm elevation causes facial plethora (redness) * caused by thyroid obstructing the thoracic inlet, increasing pressure on the venous system

Endocrine-Week 1/2 (18 decks)

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