thyroid nodules Flashcards
what are some benign thyroid nodules
- cyst
- colloid nodule
- benign follicular adenoma
- hyperplastic nodule
what are some malignant thyroid nodules
- papillary thyroid nodule
- follicular thyroid carcinoma
- medullary thyroid carcinoma
presentation of a thyroid nodule
- neck irradiation
- family history of thyroid cancer
- neck nodes
- hoarseness
- nodule moves on swallowing
- shouldn’t be painful
investigations for thyroid cancer
- TSH blood test
- USS-FNA
staging of fine needle aspiration uss
Thy1 - inadequate Thy2 U2 - benign Thy3 U3 - atypical Thy4 U4 - prob malignant Thy5 U5 - malignant
who gets papillary thyroid cancer
younger patients
-spread is lymph nodes and lungs
who gets follicular
middle aged patients
-spread by blood
who gets medullary
sporadic
what classifies a T1, T2, T3, T4a, T4b cancer
T1 - <= 2cm
T2 - > 2cm but <=4cm
T3 - >4cm limited to thyroid
T4a - any size tumour extending beyond thyroid
T4b - tumour invad or prevertebral fascia or encases carotid artery or mediastinal vessels
treatment for low risk group thyroid cancer
thyroid lobectomy
treatment for high risk group (T3 or greater)
- total thyroidectomy
- consider radio-active iodine
what does diagnosis depend on in follicular cancer
invasion of the capsule or vascular invasion
how is a minimally invasive follicular thyroid cancer treated
by thyroid lobectomy
when would you consider a total thyroidectomy
significant vascular invasion
presentation of a thyroid lymphoma
- background of auto-immune hypothyroidism
- rapid onset mass in thyroid
- females aged 70-80
what are the types of medullary thyroid cancer
- sporadic
- familial non-MEN
- familial MEN (MEN2a)
tumour marker for medullary thyroid carcinoma
calcitonin
what should be screened for in MEN2a
phaechromatocytoma
treatment for medullary carcinoma
thyroidectomy and node clearance
what is seen on CT scan with a multinodular goitre
- retrosternal extension
- tracheal compression
TSH in a multinodular goitre
usually normal, maybe slightly suppressed
treatment for a multinodular goitre
- most can leave alone
- RAI if sig hyperthyroid
- surgery if structural problem
who do you offer surgery for restrosternal goitres
patients with
- lifestyle interfering symptoms
- possibility of cancer
- significant tracheal compression if symptomatic
what is offered if there is potential of other respiratory causes of breathing difficulties
tracheal flow loops
what is treatment for a thyroid lymphoma
- core biopsy
- steroids
- R-CHOP chemotherapy
- radiotherapy
