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endocrine > thyroid nodules > Flashcards

thyroid nodules Flashcards

1
Q

thyroid masses

A

> 4cm

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2
Q

thyroid nodules

A

1 - 4 cm

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3
Q

small thyroid lesions

A

( < 1cm)
radiologically detected as they are clinically undetectable
if cancerous, are termed “microcarcinomas” when <= 10mm

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4
Q

what do follicular cells “thyrocytes” produce

A

thyroglobulin

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5
Q

what do para-follicular cells “c-cells” produce

A

calcitonin

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6
Q

what do colloid / thyroglobulin store

A

iodination in colloid
thyroxine

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7
Q

are lymphocytes infiltrative ?

A

true (any lymphocytes are infiltrative)

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8
Q

how common are thyroid nodules amongst adult UK population ?

A

5% females
1% males

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9
Q

what are the presentation of thyroid nodules ?

A

symptomatic
incidental finding (on a scan)

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10
Q

what percentage of thyroid nodules are benign / malignant ?

A

95% benign
5% malignant
(90% are differentiated thyroid cancers)

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11
Q

what percentage of cancers do thyroid cancers account for ?

A

1% of cancers (20th most common)

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12
Q

are thyroid cancers most common form of endocrine neoplasm ?

A

true

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13
Q

examination for thyroid nodules

A

inspection
feel neck triangles / lymph nodes
feel thyroid
tongue protuberance
drinking water

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14
Q

what inspection during thyroid nodule examination ?

A

eyes, neck

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15
Q

what areas of neck triangle / lymph nodes to feel

A

anterior vs posterior
levels: 2,3,4,5,6

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16
Q

thyroid function blood tests

A

TSH
calcitonin
thyroglobulin
thyroglobulin antibody
PTH (parathyroid hormone)

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17
Q

is TSH always done for thyroid function blood tests ?

A

yes

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18
Q

calcitonin always done for thyroid function ?

A

not routinely (only in history or cytology suggestive of MTC)

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19
Q

is thyroglobulin always done for thyroid function ?

A

no - only for thyroid cancer surveillance

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20
Q

is thyroglobulin antibody always done ?

A

no - only for thyroid cancer surveillance

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21
Q

is PTH (parathyroid hormone) always done ?

A

no - only if suspecting parathyroid mass

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22
Q

what is used for thyroid imaging

A

ultrasound
radioisotope scan
CT

23
Q

what is U1 grading in thyroid imaging ?

A

normal

24
Q

U2 grading

A

benign

25
Q

U3 grading

A

indeterminate / equivocal

26
Q

U4 grading

A

suspicious

27
Q

U5 grading

A

malignant

28
Q

when do you go for a radioisotope scan (if TSH supressed - <0.4mlU/L)

A

to detect cold nodule
hot nodule is toxic adenoma

29
Q

when do you use CT for thyroid imaging

A

reserved for local cancer invasion or advanced cases

30
Q

thyroid cyctology

A

ultrasound assisted (historically free-hand if >4cm)

31
Q

when do you proceed to FNAC

A

any U4 / U5
U3/4
U3 > 1.5

32
Q

**thyroid cytology

A

do I need to know about the scoring system in UK (RCP)

33
Q

non-neoplastic thyroid nodules

A

multi-nodular goitre MNG (common)
hyperplastic nodule
colloid

34
Q

non-cancerous thyroid neoplasms

A

toxic adenoma
non-invasive follicular thyroid neoplasm papillary-like nuclear features (NIFTP) pre-cancer

35
Q

differentiated thyroid cancers (90% of thyroid cancer)

A

papillary thyroid cancers 80% - various types
follicular 15% - various types
hurthle cell cancer 5%

36
Q

primary thyroid lymphoma

A

need core biopsy

37
Q

anaplastic thyroid cancer

A

<1% (very aggressive, 2 tayside cases a year)

38
Q

medullary thyroid cancer

A

1%

39
Q

metastasis to thyroid

A

(e.g. renal cancer)

40
Q

how to manage benign symptomatic nodules

A

may warrant surgery (e.g. compressive or toxic)

41
Q

how to manage high risk cancer - Thy4/Thy5 discussed at MDT to decide

A

hemithyroidectomy or total thyroidectomy + radioactive-iodine

42
Q

how to manage low risk cancer - Thy3a or Thy3f

A

diagnostic hemi-thyroidectomy
or repeat FNA

43
Q

how to manage surgical pathology

A

benign pathology with description or…
cancer type w/ TNM staging

44
Q

if diagnostic hemi-thyroidectomy showed cancer:

A

surveillance
completion thyroidectomy + radioactive iodine

45
Q

(complications of thyroidectomy) seroma

A

common & settles (<5%)

46
Q

(complications of thyroidectomy) superficial haematoma

A

common & settles. consider evacuation if large

47
Q

(complications of thyroidectomy) hypocalcaemia

A

only after total thyroidectomy (parathyroid function)

48
Q

(complications of thyroidectomy) wound infection

A

uncommon (<5%) if in doubt give antibiotics

49
Q

(complications of thyroidectomy) scar

A

abnormal scarring uncommon (<5%) . body image/psychology affecrs QOL

50
Q

(complications of thyroidectomy) stridor

A

deep haematoma causing laryngeal oedema. rare (<1%)

51
Q

(complications of thyroidectomy) RLN injury

A

voice change & swallow problems. a spectrum

52
Q

(complications of thyroidectomy) chyle leak

A

possible with left level vi lymph node dissection

53
Q

(complications of thyroidectomy) other nerve injuries

A

endocrine (15 decks)

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