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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)

A

Papillary

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)

A

Lymph

25
Q

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.

A

Follicular Thyroid Carcinoma

26
Q

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

A

blood

27
Q

Most common sites of Follicular Thyroid Carcinoma blood born metastases are

A

lung and bone

28
Q

Treatment for PTC and FTC

A

Surgery–> Radioiodine Tx & high dose thyroid hormone replacement to keep TSH low

29
Q

Recurrence of PTC and FTC are monitored by

A
  • Thyroglobulin
  • Neck U/S
  • Whole Body Iodine Scans
30
Q

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)

A

Medullary Thyroid Carcinoma

31
Q

Histologic findings for Medullary Thyroid Carcinoma

A

Neuroendocrine appearance with packets of round, oval, and spindle-shaped cells; Stroma filled with “Amyloid”

32
Q

Treatment for MTC

A

Surgery –> thyroid hormone replacement to maintain NORMAL TSH level

33
Q

Recurrence of MTC is monitored by

A

Calcitonin and Neck U/S

34
Q

________ inhibitors are approved for metastatic or refractory MTC

A

tyrosine kinase inhibitors

35
Q

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

A

Anaplastic Thyroid Carcinoma

36
Q

Treatment for ATC

A

usually inoperable so focus should be on palliative care

37
Q

Thyroid enlargement

A

Goiter

38
Q

Non-toxic goiter is aka

A

Euthyroid or Hypothyroid

39
Q

Toxic goiter is aka

A

Hyperthyroid

40
Q

Non-toxic goiter due to intra-thyroid nodules is

A

non-toxic multinodular goiter

41
Q

Non-toxic goiter due to diffuse thyroid enlargement is caused by

A

Iodine deficiency
Goitrogens
Chronic Lymphocytic Thyroiditis (Hashimoto’s)

42
Q

Toxic goiter due to intra-thyroid nodules is

A

Toxic multinodular goiter (more common)

Toxic uninodular goiter

43
Q

Toxic goiter due to diffuse thyroid enlargement is caused by

A

Diffuse Toxic Goiter (Grave’s disease)

44
Q

Most common cause of Goiters worldwide

A

Iodine-deficiency (Endemic goiter)

45
Q

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

A

Non-Toxic Multinodular Goiter

46
Q

Multinodular goiter is (toxic/nontoxic) if TSH is normal

A

Non-toxic

47
Q

Multinodular goiter is (toxic/nontoxic) if TSH is low

A

Toxic

48
Q

Treatment for Multinodular goiter

A
  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
Q

What are compressive symptoms?

A

Choking, dysphagia, hoarseness, facial edema, and dyspnea

50
Q

What sign is used to evaluate venous obstruction in patients with goiters?

A

Pemberton’s Sign

51
Q

Pemberton’s Sign is POSITIVE when

A

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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