Thyroid Nodules Flashcards
What are adjunctive treatment following surgery for thyroid cancer?
Radiation iodine (with recombinant TSH)
Thyroxine - to suppress the TSH (<0.1mU/L for high risk)
How long might you suppress someone with thyroxine? Why stop?
5 years max
Can develop osteoporosis and arrhythmias
How might you investigate a thyroid nodule?
TFT
Thyroid US
On nuclear medicine scan, what type of thyroid nodule is highest risk of cancer; cold, normal, or hot?
Cold
When do you operate on a multinodular goitre?
If it’s size is cause symptoms
If it’s cancer
If it’s large or increasing in size
What are the two medical options for the treatment of hyperthyroidism
Carbimazole
Propylthiouracil
What are the treatment options of a toxic thyroid nodule?
Medical - carbinazole, propylthriouracil
Surgical removal
Radtioactive iodine
What is the name for a patient with low TSH and normal T3 and T4 who is asymptomatic?
Asymptomatic hyperthyroidism
How does hyperthyroidism cause osteoporosis?
T3 directly stimulates osteoclasts and osteoblasts
How do you determine whether to perform a total thyroidectomy or a hemithyroidectomy?
Total if nodule is >1cm
Hemithyroidectomy if <1cm
What are the pro’s and con’s of total thyroidectomy vs hemithyroidectomy?
Total:
- Papillary thyroid cancer is often bilateral
- Adjuvant RAI
- No chance of contralateral spread
- Nothing to find on future US’
- Allows thyroglobulin measurement as a follow up
Cons:
- No long term mortality benefit
- Less complications with hemi
When do you do a central dissection for LNs?
When they are found to be involved
When the disease is advanced, nodule is >4cm
How do you follow up a patient post surgical removal of a thyroid cancer?
Clinical exam 12monthly
US 12 monthly
Thyroglobulin 12monthy
