Thyroid Nodules

Question 1

What are the two main classifications of nodule?

Answer 1

Solitary Thyroid Nodule

Multinodular goitre

Question 2

The vast majority of Solitary Thyroid Nodules are benign. TRUE/FALSE?

Answer 2

TRUE

Question 3

What benign pathologies can present as a solitary thyroid nodules?

Answer 3

Cyst
Colloid Nodule
Benign Follicular adenoma
Hyperplastic Nodule

Question 4

5% of solitary thyroid nodules are malignant. Give examples of what pathologies could cause this

Answer 4

PAPILLARY THYROID CARCINOMA – 80%
Follicular Thyroid Carcinoma
Medullary Thyroid Carcinoma

Question 5

If a solitary nodule moves on swallowing where is it sitting?

Answer 5

Invested in Pre-tracheal fascia

Question 6

If a patient presents with a painful solitary nodule, what is thought to cause this?

Answer 6

intra thyroidal into a cyst

Question 7

What should be asked about in the patients history to determine possible causes of the solitary nodule?

Answer 7

• Previous Neck irradiation

- FHx of thyroid Cancer

Question 8

What should be checked on examination of a solitary thyroid nodule?

Answer 8

• Neck nodes

- Hoarseness

Question 9

What investigations are carried out on investigation of a solitary thyroid nodule?

Answer 9

• TSH

- Ultrasound +/- Fine Needle Aspiration

Question 10

How are US/FNA tests graded with regards to thyroid cancer?

Answer 10

Thy1 – inadequate                 U1
Thy2 – Benign			U2
Thy 3 (a/f) – Atypical		U3	
Thy4 – Prob malignant   	U4
Thy 5 – malignant		        U5

Question 11

How are differentiated thyroid cancers treated?

Answer 11

If low risk (<4cm) => Lobectomy

If high risk => total thyroidectomy +/- radioactive iodine

Question 12

What are the two types of differentiated thyroid cancer?

Answer 12

Papillary

Follicular

Question 13

How do follicular thyroid carcinomas spread?

Answer 13

Haematogeneous spread

Question 14

Most follicular thyroid carcinomas are minimally invasive. TRUE/FALSE?

Answer 14

TRUE

Question 15

How is a thyroid lymphoma usually investigated and treated?

Answer 15

Ix = Core Biopsy

Tx =

• Steroids
• Chemotherapy
• Radiotherapy

Question 16

Where does a medullary thyroid carcinoma originate and what does it secrete?

Answer 16

tumour of the parafollicular cells

secrete CALCITONIN

Question 17

If a fine needle aspiration shows evidence of amyloid or Calcitonin positive stains, this indicates a Medullary Thyroid Carcinoma. TRUE/FALSE?

Answer 17

TRUE

Question 18

What investigations can be carried out for a Multinodular Goitre?

Answer 18

TSH levels

CT Scan

Question 19

What are TSH levels usually like in a multinodular goitre?

Answer 19

normal or slightly suppressed

Question 20

What can a CT Scan show in multinodular goitre?

Answer 20

Retrosternal Extension

Tracheal Compression

Question 21

What treatment can be given if doctors are concerned about a multinodular goitre?

Answer 21

Radioactive Iodine if significantly hyperthyroid

Surgery if structural problem

Question 22

Who should be offered surgery for a multinodular goitre?

Answer 22

• Lifestyle interfering symptoms
• Possibility of cancer
• Significant tracheal compression (?<7 mm)
• Tracheal Flow Loops