Thyroid Nodules Flashcards
What are the two main classifications of nodule?
Solitary Thyroid Nodule
Multinodular goitre
The vast majority of Solitary Thyroid Nodules are benign. TRUE/FALSE?
TRUE
What benign pathologies can present as a solitary thyroid nodules?
Cyst
Colloid Nodule
Benign Follicular adenoma
Hyperplastic Nodule
5% of solitary thyroid nodules are malignant. Give examples of what pathologies could cause this
PAPILLARY THYROID CARCINOMA – 80%
Follicular Thyroid Carcinoma
Medullary Thyroid Carcinoma
If a solitary nodule moves on swallowing where is it sitting?
Invested in Pre-tracheal fascia
If a patient presents with a painful solitary nodule, what is thought to cause this?
intra thyroidal into a cyst
What should be asked about in the patients history to determine possible causes of the solitary nodule?
- Previous Neck irradiation
- FHx of thyroid Cancer
What should be checked on examination of a solitary thyroid nodule?
- Neck nodes
- Hoarseness
What investigations are carried out on investigation of a solitary thyroid nodule?
- TSH
- Ultrasound +/- Fine Needle Aspiration
How are US/FNA tests graded with regards to thyroid cancer?
Thy1 – inadequate U1 Thy2 – Benign U2 Thy 3 (a/f) – Atypical U3 Thy4 – Prob malignant U4 Thy 5 – malignant U5
How are differentiated thyroid cancers treated?
If low risk (<4cm) => Lobectomy
If high risk => total thyroidectomy +/- radioactive iodine
What are the two types of differentiated thyroid cancer?
Papillary
Follicular
How do follicular thyroid carcinomas spread?
Haematogeneous spread
Most follicular thyroid carcinomas are minimally invasive. TRUE/FALSE?
TRUE
How is a thyroid lymphoma usually investigated and treated?
Ix = Core Biopsy
Tx =
- Steroids
- Chemotherapy
- Radiotherapy
Where does a medullary thyroid carcinoma originate and what does it secrete?
tumour of the parafollicular cells
secrete CALCITONIN
If a fine needle aspiration shows evidence of amyloid or Calcitonin positive stains, this indicates a Medullary Thyroid Carcinoma. TRUE/FALSE?
TRUE
What investigations can be carried out for a Multinodular Goitre?
TSH levels
CT Scan
What are TSH levels usually like in a multinodular goitre?
normal or slightly suppressed
What can a CT Scan show in multinodular goitre?
Retrosternal Extension
Tracheal Compression
What treatment can be given if doctors are concerned about a multinodular goitre?
Radioactive Iodine if significantly hyperthyroid
Surgery if structural problem
Who should be offered surgery for a multinodular goitre?
- Lifestyle interfering symptoms
- Possibility of cancer
- Significant tracheal compression (?<7 mm)
- Tracheal Flow Loops
