Thyroid Nodules Flashcards
what are the four types of thyroid carcinoma?
papillary
follicular
medullary
anapaestic
are most solitary thyroid nodules benign or malignant?
benign
what investigations are done for a solitary thyroid nodule?
TSH
USS FNA
on USS-FNA of a thyroid nodule, what does thy 1 mean?
inadequate sample
on USS-FNA of a thyroid nodule, what does thy 2/U2 mean?
benign
on USS-FNA of a thyroid nodule, what does thy 3/U3 mean?
atypical
on USS-FNA of a thyroid nodule, what does thy 4/U4 mean?
probably malignant
on USS-FNA of a thyroid nodule, what does thy 5/U5 mean?
malignant
what makes a DTC low risk?
age <50
tumour <4cm
how is a DTC managed in the low risk group?
thyroid lobectomy
what makes a DTC high risk?
T3 or greater
how is a DTC managed in the high risk group?
total thyroidectomy
what staging systems can be used to predict the outcome of a DTC?
AMES
TNM
what does it mean if a DTC is T1?
tumour size less than 2cm
what does it mean if a DTC is T2?
tumour size 2-4cm
limited to the thyroid
what does it mean if a DTC is T3
tumour size >4cm
limited to the thyroid/minimal extension
what does it mean if a DTC is T4a?
moderately advanced
any size extending beyond the thyroid capsule
what does it mean if a DTC is T4b?
very advanced disease
what does it mean if a DTC is N0?
no lymph node mets
what does it mean if a DTC is N1?
regional lymph node mets
what does it mean if a DTC is N1a?
metastatis to near lymph nodes
what does it mean if a DTC is N1b?
mets to further lymph nodes
what does it mean if a DTC is M0?
no distant mets
what does it mean if a DTC is M1?
there are distant mets
what is the follow up for a DTC?
TSH and thyroglobulin measured bi-annually for 5 years then annually for the next 5
what two cancers are considered to be DTC’s?
papillary
follicular
what is a tumour marker for DTC’s?
thyroglobulin
what are the two types of follicular thyroid carcinomas?
minimally invasive
widely invasive
how does a follicular thyroid carcinoma spread?
haematogenous
what type of follicular thyroid carcinoma is more common?
minimally invasive
how is minimally invasive follicular thyroid carcinoma usually treated?
thyroid lobectomy
what do patients with thyroid lymphoma usually have a history of?
autoimmune hypothyroidism
how does thyroid lymphoma present?
rapid onset mass in the thyroid
what is the typical patient with thyroid lymphoma?
female aged 70-80
how is a thyroid lymphoma diagnosed?
core biopsy for histology
what are the three stages of the treatment regime for thyroid lymphoma?
steroids
R CHOP chemotherapy
radiotherapy
what is medullary thyroid carcinoma?
a tumour of the parafollicular cells
what can be used as a tumour marker in medullary thyroid carcinoma?
calcitonin
what are the three types of medullary thyroid carcinoma?
sporadic
familial - non MEN
familial - MEN
which MEN is most commonly associated with medullary thyroid carcinoma?
MEN2a
what should be checked if someone has medullary thyroid carcinoma and why?
urinary metanephrines and genetics
look for MEN
what should be considered if someone has MEN2?
prophylactic thyroidectomy as a child
what is TSH like in multi nodular goitre?
usually normal/slightly supressed
