Thyroid nodules Flashcards
What are thyroid nodules?
lumps in thyroid gland different from thyroid tissue
Are thyroid nodules common?
yes
When do you feel thyroid nodules?
- on palpitation
- Single or multiple and sometimes form of pre-existing goitre
What are the diffuse causes of goitre?
- Physiological
- Grave’s disease
- Hashimoto’s thyroiditis
- Subacute thyroiditis
What are the nodular causes of goitre?
- Multinodular goitre
- Adenoma
- Carcinoma
What are two different types of thyroid nodules?
- functional
2. non-functional
What investigations are used for thyroid nodules?
TFTs
What are TFTs in functional thyroid nodules?
- High T3 and T4
2. Low TSH
What are TFTs like in non-functional thyroid nodule?
normal or high TSH and normal T3 and T4
What is toxic thyroid adenoma usually associated with?
- hyperthyroidism
- young age
What is the TSH like in toxic thyroid adenoma?
normal
How do you treat and scan a toxic thyroid adenoma?
- Usually single large thyroid nodule
1. Thyroid scan with hot area and suppression of extra nodular thyroid tissue
2. Treatment: radioactive iodine therapy
What are RF for thyroid cancer?
- Prior radiation
- Fhx
- Over 65 or under 30
- Voice changes, difficulty breathing or swallowing
- Firm or hard on palpation or fixed or during swallowing
What would multiple nodules on a scintrgrapahic scan suggest?
toxic multinodualr goitre
How do you treat toxic multinodular goitre?
radioiondine therapy
Which type of nodule has a lower risk of cancer?
functional
What would high risk thyroid US show?
- solid
- hypo
- irregular margins
- microcalcification
- FNA is unsure
When do you do FNA for thyroid nodules?
- If >1cm in high or intermediate risk: FNA
- If >1.5cm in low risk: FNA
- If >2cm in very low risk: FNA
What are different types of thyroid cancer?
- Papillary
- Follicular
- Medullary
- Lymphoma
- Anaplastic
Which thyroid cancers are differentiated
- Papillary
2. Follicular
Which thyroid cancers are undifferentiated?
Anaplastic
Which type of thyroid cancer is most common?
papillary
What are RF for papillary thyroid cancer?
- Radiation exposure
2. Affects young people
What are the buzzwords for papillary thyroid cancer?
- Psammoma bodies
2. Orphan Anne Nuclei
Who does follicular thyroid cancer affect?
middle aged women especially
What are buzz words for follicular thyroid cancer?
Hurthle cells
What is Medullary thyroid cancer associated with?
MEN2 (?FHx)
Who does lymphoma thyroid cancer usually affect?
- More common in females
- Generally occurs after pre-existing Hashimot’s’s thyroiditis
Who does anaplastic thyroid cancer affect?
Elderly females
What are buzz words for anaplastic thyroid cancer?
- giant cells
2. pleomorphic hyperchromatic nuclei
What are differential diagnosis for thyroid nodules?
- Colloid nodule
- Thyroid adenoma
- Non-toxic multinodular goitre
- Thyroid cancer
What investigations do you do for thyroid nodules?
- TSH levels
2. Thyroid US
How do you treat follicular and papillary thyroid cancer?
-Surgical removal
-After total thyroidectomy:
High risk: Radioiodine therpay and lifelong suppression with T4
How do you treat medullary thyroid cancer?
Always totally thyroidectomy
How do you treat anaplastic thyroid cancer?
- complete thyroidectomy
- chemotherpay
- radiotherapy
