Thyroid Nodules

Question 1

when should you do FNA for thyroid?

Answer 1

increase blood flow on doppler
fhx
more than 1cm size
microcalcifications
past radiation exposure
hoarse voice

Question 2

what thyroid cancer do you get with radiation?

Answer 2

follicular thyroid cancers

Question 3

possible outcomes of thyroid FNA?

Answer 3

0
1-non-diagnostic
2-benign
3-follicular lesion, undetermined significance (5-10% malignant)
4- follicular neoplasm (20-30% malignant)
5 - suspicious for malignancy (50-75% of malignancy)
6- malignant

Question 4

if you have category 4 follicular neoplasm of thyroid: what to do after?

Answer 4

check TSH levels
low - non functioning: surg, high functioning: observe
normal - surgery

Question 5

after dx of thyroid malignancy, what to do?

Answer 5

examine neck
ultrasound to stage it

if lymph node positive, you do FNA

Question 6

lymph node for thyroid after FNA, request for what?

Answer 6

cytology

thyroglobulin

Question 7

CT of thyroid, what not to give? why?

Answer 7

don’t give contrast

may saturate thyroid cells, may need radiopharma

Question 8

when do total thyroidectomy?

Answer 8

> 1cm nodule

Question 9

when do hemi-thyroidectomy?

Question 10

multifocal and bilateral type of thyroid cancer?

Answer 10

papillary thyroid carcinoma

Question 11

most common place for thyroid mets?

Answer 11

level 6 and 7, para tracheal or central lymphnodes

Question 12

adjunctive Rx of thyroid cancer

Answer 12

radioactive iodine

thyroxine (aim to suppress TSH

Question 13

long term TSH suppression risks?

Answer 13

osteoporosis

arrythmias/AF

Question 14

survival rate for thyroid cancers?

Answer 14

98% at 20 years

Question 15

what to ask history of someone with thyroid lump?

Answer 15

pressure symptoms
dysphagia
pain
breathing difficulties

Question 16

when operate if someone with multi-nodular goitres?

Answer 16

operate if symptomatic
if cancer
if big or increasing in size
retrosternal extension

Question 17

what is a significant change in thyroid nodule size?

Answer 17

increase volume by 50%

>20% in nodule dimension

Question 18

hyperthyroid/thyrotoxicosis in someone with a single nodule?

Answer 18

Grave’s

toxic nodule

Question 19

toxic nodule nuclear medicine scan see what?

Answer 19

nodule: increase uptake

suppressed other parts of thyroid

Question 20

grave’s disease nuclear medicine scan see what?

Answer 20

diffuse uptake of thyroid

Question 21

treatment options for toxic nodule? recommended

Answer 21

meds
surg
radioactive iodine (recommended)

Question 22

med treatments for toxic thyroid nodule? cure?

Answer 22

carbimazole
propylthiouracil

not cure, good useful as short term measure

Question 23

if you get an abnormal thyroid function? what tests to do next?

Answer 23

TFT repeat
anti-thyroid antibodies
thyroid ultrasound

AntiTPO
antithyroid globulin