Thyroid nodules Flashcards
What is the thyroid’s function?
The main purpose of this organ is to produce, store and secrete the iodine-based hormones triiodothyronine (T3) and thyroxine (T4). These hormones have various effects on fat, protein and carbohydrate metabolism, as well as on the development especially central nervous system and general growth.
What are the thyroid hormones used for?
The T4, or rather the T3 derived from it, and the T3 released directly by the thyroid gland influence the metabolism of your body cells. In other words, it regulates the speed with which your body cells work. If too much of the thyroid hormones are released, the body cells work faster than normal, and you have hyperthyroidism (overactive thyroid). If you become hyperthyroid because of too much thyroid hormone, the increased activity of your body cells or body organs may lead, for example, to a quickening of your heart rate or increased activity of your intestine so that you have frequent bowel motions or even diarrhoea.
On the other hand, if too little of the thyroid hormones are produced, the cells and organs of your body slow down. This is known as hypothyroidism (underactive thyroid). If you become hypothyroid, your heart rate, for example, may be slower than normal and your intestines may work sluggishly, so you become constipated.
Give 6 types of thyroid nodules:
1) single thyroid nodule
2) multinodular goitre
3) retrosternal goitre
4) thyroid cysts
5) thyroid follicular adenoma
6) thyroid cancer
Name 4 types of thyroid cancer:
1) papillary thyroid cancer
2) follicular carcinoma
3) medullary thyroid cancer
4) anaplastic thyroid carcinoma
What is the most common type of thyroid cancer?
papillary thyroid cancer
What is the second most common type of thyroid cancer?
follicular carcinoma
What is the most aggressive type of thyroid cancer?
anaplastic thyroid carcinoma
What thyroid cancer is associated with MEN type 2a?
medullary thyroid cancer
True or false: benign thyroid disease e.g. Hashimoto’s increases risk of thyroid cancer
true
What is papillary thyroid cancer?
Papillary thyroid cancer typically develops from the follicular cells of the thyroid gland. It is characterized by its small, finger-like projections called papillae.
Papillary thyroid cancer tends to be less aggressive and less likely to spread beyond the thyroid gland than other types of thyroid cancer.
While it may spread to nearby lymph nodes, papillary thyroid cancer typically doesn’t spread to distant organs, such as the lungs or bones.
What is follicular carcinoma?
Follicular carcinoma (also called Follicular thyroid cancer) is called a “well differentiated” thyroid cancer like papillary thyroid cancer, but it is typically a bit more malignant (aggressive) than papillary cancer. Follicular thyroid cancer occurs in a slightly older age group than papillary thyroid cancer does and is also less common in children. In contrast to papillary thyroid cancer, follicular thyroid cancer occurs only rarely after radiation exposure.
What is anaplastic thyroid cancer?
Anaplastic thyroid cancer is one of the most aggressive and fastest-growing types of cancer. It can grow and spread rapidly in a matter of weeks.
About 50% of people with ATC have metastasis (cancer spread) in distant areas of their body at diagnosis. The most common sites of distant metastasis in ATC are your lungs, bones and brain.
Give 6 clinical presentations associated with thyroid cancer:
1) neck lump
2) hoarse
3) dysphagia
4) odynophagia
5) weight loss
6) fatigue
What is odynophagia?
painful swallowing
What blood test can be used if MEN is suspected?
plasma calcitonin and carcinoembryonic antigen
Name 3 imaging techniques used for thyroid cancer:
1) ultrasound
2) CT/MRI (for metastases)
3) fine needle aspiration for histology
What is the referral guidance for an unexplained thyroid lump
2 week wait referral
What is the typical treatment for thyroid cancer?
thyroidectomy (with life long levothyroxine) followed by radioactive remnant ablation to destroy any residual thyroid cells after surgery
What serum marker can be used to monitor signs of thyroid cancer recurrence following thyroidectomy?
serum thyroglobulin (this is produced only by follicular cells and so when raised, it implies recurrence)
what is a goitre?
what are the two types?
an abnormal enlargement of the thyroid gland
- smooth goitre (enlargement of the thyroid gland without distinct nodules)
- nodular goitre (one or more distinct nodules within the thyroid gland that are hot (functioning) or cold (non-functioning)
what is the most common cause of a thyroid goitre in the UK and globally?
Uk = Grave’s disease
Globally = iodine deficiency
what is the aetiology of a smooth thyroid goitre?
- Grave’s disease (hyperthyroidism)
- Hashimoto’s disease (hypothyroidism)
- drugs (lithium and amiodarone)
- iodine deficiency/excess
- De Quervain’s thyroiditis
- sarcoidosis and haemochromatosis that infiltrate to the thyroid gland
what is the aetiology of a nodular thyroid goitre?
- toxic solitary adenoma
- non-functional thyroid adenoma
- multinodular goitre
- thyroid cyst
- thyroid cancer
what are the clinical features of a goitre?
- visible or palpable neck swelling that moves up with swallowing but not tongue protrusion
- hoarseness
- difficulty swallowing or breathing (if large)
- symptoms of underlying cause eg hyper/hypothyroidism
