Thyroid Nodules Flashcards
What are the causes of thyroid nodules
Benign:
Multinodular goitre
Thyroid adenoma
Hashimoto’s thyroiditis
Cysts (colloid, simple, haemorrhagic)
Malignant (5%)
Papillary carcinoma (most common malignant cause)
Follicular carcinoma
Medullary carcinoma
Anaplastic carcinoma
Lymphoma
Features of papillary thyroid cancer (epidemiology, tumour marker, spread, histology)
Most common (80%)
Tumour marker: Thyroglobulin
Spread: Lymph nodes and lung
Histology: Psammoma bodies (foci of calcification), empty appearing nuclei with central clearing (Orphan Annie eyes)
Features of follicular thyroid cancer (tumour marker, spread, histology)
Well-differentiated but spreads early
Tumour marker: Thyroglobulin
Spread: Blood»_space; lungs, bone, liver, breast, adrenals
Histology: Fairly uniform cells forming small follicles,
reminiscent of normal thyroid
Features of medullary thyroid cancer (association, tumour marker, spread, histology)
Associated with MEN2
Neuroendocrine neoplasm derived from parafollicular C
cells secreting calcitonin
Tumour marker: CEA, calcitonin
Histology: Sheets of dark cells, amyloid deposition within
tumour (calcitonin broken down to amyloid)
Features of anaplastic thyroid cancer (spread, histology)
Early and wide metastases common
Spread: very aggressive → local, lymph nodes, blood
Histology: Undifferentiated follicular, large pleomorphic giant
cells, spindle cells with sarcomatous appearance
Risk factors for thyroid cancer
Head and neck irradiation
Female sex
FMHx
Hashimoto’s thyroiditis → lymphoma
BRAF mutations → papillary
Symptoms of thyroid cancer
Midline neck lump
Hoarseness
Dyspnoea
Dysphagia
Rapid neck enlargement
Anaplastic: compression symptoms (hoarseness, dyspnoea, dysphagia)
Signs of thyroid nodules on examination
Palpable thyroid nodule
- Moves with swallowing
Tracheal deviation
Cervical lymphadenopathy
Investigations for thyroid nodules
Suspected cancer → 2WW ENT
TFTs: normal OR deranged
Serum thyroglobulin: tumour marker
Bone profile: serum calcitonin (tumour marker)
Genetic testing
US neck: nodule number and characteristics
Fine needle biopsy/core biopsy
Laryngoscopy: paralysed vocal cord suggests malignancy
I-123 thyroid scan: ?hot nodule
CT neck: lymph node status
Management for thyroid cancer
First line: surgery (lobectomy to thyroidectomy)
- must be euthyroid first - beta blocker + carbimazole for 4-6 weeks
Post-op
Radioactive iodine therapy
Lifelong thyroxin therapy
Targeted therapy
Complications of treatment for thyroid cancer
Thyroidectomy
- Hypoparathyroidism
- Recurrent laryngeal nerve damage
- Bleeding
Radioiodine
- Secondary tumours
- Dry mouth
- Bone mineral loss
