Thyroid Nodule Management Flashcards
name the 2 kinds of benign thyroid nodule?
solitary thyroid nodule
multinodular goitre
what percentage of solitary thyroid nodules are benign?
95%
what could cause a solitary thyroid nodule?
cyst
colloid nodule
benign follicular adenoma
hyperplastic nodule
what is the most likely malignant diagnosis of a solitary thyroid nodule?
papillary thyroid carcinoma
what thyroid cancers could present with a solitary thyroid nodule?
papillary thyroid carcinoma
follicular thyroid carcinoma
medullary thyroid carcinoma
what clinical feature would show that the nodule is in the thyroid gland?
moves on swallowing
why does the thyroid move with swallowing?
sits in a sheath derived from the pretracheal fascia
what 2 history questions should you ask to differentiate a malignant from a benign nodule?
neck irradiation
FH of thyroid cancer
what would enlarged neck lymph nodes along with a thyroid nodule indicate?
papillary thyroid carcinoma until proven otherwise
what would a hoarse voice indicate?
recurrent laryngeal nerve palsy
what investigations should be done for a suspected malignant thyroid nodule?
TSH levels
USS guided fine needle aspiration
what is the only area of the thyroid to not be supplied by the recurrent laryngeal nerve?
cricothyroid
what would you expect to see on fine needle aspiration of a benign nodule?
macrophages
colloid
what is the normal range for TSH?
0.4-4mU/l
what investigation is good for looking for enlarged cervical lymph nodes?
USS
what 2 criteria would define you as low risk for thyroid cancer?
<50
tumour <4cm
how should low risk patients with thyroid carcinoma be treated?
lobectomy
how should high risk patients with thyroid cancer be treated?
total thyroidectomy
radioactive iodine
what size would a thyroid tumour have to be to be T2 in the TNM classification?
> 2cm but <4cm
what tumour marker can be used for papillary and follicular thyroid cancer?
thyroglobulin
how often should TSH and Tg be monitored in a cured thyroid cancer patient?
every 6 months for 5 years
how does follicular thyroid cancer spread?
haematogenously
most common form of follicular thyroid cancer?
minimally invasive follicular thyroid cancer
treatment for minimally invasive follicular thyroid cancer?
thyroid lobectomy
when would you do a total thyroidectomy in minimally invasive follicular thyroid cancers?
if there is significant vascular invasion
what cancer presents with a U3Thy3f lesion?
minimally invasive follicular thyroid cancer
clinical presentation of thyroid lymphoma?
rapid onset of a mass in an elderly female who has a history of hypothyroid
treatment for thyroid lymphoma?
chemo
steroids
radiotherapy
3 types of medullary thyroid carcinoma?
sporadic
familial
non familial
investigations for multinodular goitre?
TSH
CT scan
results of TSH levels in multinodular goitre?
normal or slightly low
what would you suspect in a high TSH and high free T4/3?
pituitary tumour
results of CT in suspected multinodular goitre?
retrosternal extension
tracheal compression
what respiratory complication is asociated with multinodular goitre?
stridor
how should multinodular goitre be treated?
leave
radioactive iodine if really hypo
what can multinodular look like on CXR?
superior mediastinal mass with tracheal deviation
