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ENDOCRINE > THYROID NODULES > Flashcards

THYROID NODULES Flashcards

1
Q

what are thyroid nodules?

A

disordered growth of thyroid cells that form a lump or mass
can be a discrete nodule or a multinodular goiter
extremely common

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2
Q

are thyroid nodules always bad?

A

they can be palpated by the patient or PA or discovered incidentally

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3
Q

what are 90% of thyroid nodules?

A

benign adenomas, colloid nodules or cysts

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4
Q

what are the other 10% of thyroid nodules?

A

primary thyroid malignancy
metastatic malignancy

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5
Q

are nodules more common in males or females?

A

females

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6
Q

what are the risks for malignant nodules?

A
  • males
  • young age (<30 y/o)
  • history of head-neck radiation
  • FMHx thyroid cancer
  • personal hx of another malignancy
  • large, firm, solid solitary nodule or “cold nodule”
  • associated cervical LAD
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7
Q

what is the clinical presentation of of thyroid nodules?

A
  • asymptomatic
  • symptoms:
    > nodules or multinodular goiter thats visible
    > ant. neck discomfort
    > hoarseness
    > dysphagia
    > ipsilateral recurrent laryngeal nerve palsy
    > hypothyroidism/hyperthyroidism - depends if fxning or not- fxning
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8
Q

on what different imaging methods can thyroid nodules be found?

A
  1. carotid ultrasound
  2. neck or chest CT
  3. PET

-no sx or observable lesion by exam -> thyroid cancer needs to be ruled out

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9
Q

what measurement of nodule requires further testing?

A

> or equal to 1
< 1cm in patients at high risk for thyroid cancer

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10
Q

what should all nodules be initially evaluated with?

A

thyroid ultrasound

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11
Q

in nodules > or greater than 1 cm and/or high-risk patient what labs should be drawn and what might they show?

A
  1. TSH and free T4
    • may be low, normal, or high
    • majority of patients are EUTHROID
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12
Q

why is thyroid US useful?

A

determines nodule size and characteristics (including adjacent structures)

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13
Q

what are benign features of thyroid nodules seen on US?

A

purely cystic, without solid components

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14
Q

what are high-risk features of thyroid nodules seen on US?

A

solid, hypoechoic- indicates solid mass of dense tissue , microcalcifications, irregular margins, extrathyroidal extension

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15
Q

when should a radionuclide thyroid scan be performed and what is the goal?

A
  1. performed when TSH is low
  2. goal is to examine if nodule is fucntioning or non-functioning
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16
Q

what is a nonfunctioning nodule referred to as and what is a hyperfunctioning nodule referred to as?

A

nonfunctioning: cold
hyperfunctioning: hot

17
Q

what does a “cold” nodule mean?

A

iodine uptake less than surrounding tissue
must do FNA Biopsy

(everything got uptake except the nodule)

18
Q

what does a “hot” nodule mean?

A

iodine uptake more than surrounding tissue
likely benign
repeat labs at 6 months

(only uptake in the nodule… will see black circle)

19
Q

what is the best diagnostic method for assessing malignancy?

A

FNA Biopsy

20
Q

what are indications for a FNA B?

A
  1. > or equal to 1 cm nodule AND:
    - elevated/normal TSH + suspicious ultrasound findings
    OR
    • low TSH + suspicious ultrasound findings +cold or indeterminate nodule (s)
  2. large nodule > or equal to 1.5 cm
  3. thyroid nodule of any size w/ risk factors:
    - young age
    - FMHx of thyroid cancer
    - hx radiation
21
Q

what is the treatment of a benign lesion?

A
  1. repeat ultrasound every 6 months initially
  2. in a stable lesion: repeat ultrasound yearly
  3. repeat FNA biopsy if growth occurs
    - >2 mm of growth per year- higher likelihood of malignancy
  4. can do suppression therapy with levothyroxine!!!!
    • nodules <2 cm and/or increased TSH
    • starting dose of 50 mcg PO daily
22
Q

what is the tx for a cancerous lesion?

A

total thyroidectomy

23
Q

what is a goiter?

A

chronic enlargement of the thyroid gland d/t non-neoplastic growth

can be overall enlargement or irregular cell growth that forms one or more nodules

24
Q

what are the types of goiter?

A
  1. toxic- associated wtih hyperthyroidism
  2. nontoxic- associated with euthroidism
  3. hypothyroid- commonly seen in hashimotos thyroiditis
25
Q

what is “other tx” for benign lesions? (later line)

A

OTHER TX:
1. radiofrequency ablation for lesions > or equal to 3 cm
2. radioiodine therapy for hyperthyroid patients with toxic thyroid adenomas or multinodular goiter

ENDOCRINE (18 decks)

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