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Gen Surg (Breast and Thyroid) > Thyroid - Nodules > Flashcards

Thyroid - Nodules Flashcards

1
Q

Which abnormality of the thyroid presents as a neck swelling that moves on swallowing and classically moves upwards on protrusion of the tongue?

A

Thyroglossal cyst

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2
Q

How is a thyroglossal cyst treated?

A

Surgical excision (Sistrunk procedure)

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3
Q

Who are malignant thyroid nodules most likely to be seen in?

A

Males, children and those aged > 60

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4
Q

What are the two major risk factors for thyroid cancer?

A

History of radiation to the neck, family history of thyroid cancer

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5
Q

If you are investigating a solitary thyroid nodule and the patient has a family history of medullary carcinoma, what additional test should be ordered?

A

Serum calcitonin

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6
Q

If you are investigating a solitary thyroid nodule and you suspect a MEN mutation, what investigation should be done to exclude a phaeochromocytoma prior to surgery?

A

24h urinary catecholamines

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7
Q

A screen for MEN mutations should always be done before surgery for medullary carcinoma. Why is this?

A

To exclude a phaeochromocytoma

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8
Q

What is the first line imaging investigation for a thyroid nodule?

A

Ultrasound

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9
Q

Are malignant thyroid nodules more likely to be hot or cold on radioisotope scanning?

A

Cold

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10
Q

What is the only investigation that can differentiate between benign and malignant thyroid nodules?

A

FNA and cytology

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11
Q

Why do all follicular neoplasms require surgery?

A

Because it is impossible to differentiate between adenomas and carcinomas

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12
Q

What differentiates a follicular carcinoma from a follicular adenoma?

A

Capsular invasion

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13
Q

What is the most common benign thyroid tumour?

A

Follicular adenoma

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14
Q

What does a follicular adenoma become known as when it is functioning?

A

Toxic follicular adenoma

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15
Q

What is the initial treatment of choice for all follicular neoplasms of the thyroid?

A

Thyroid lobectomy

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16
Q

Describe the typical presentation of a thyroid cancer?

A

A solitary thyroid nodule in a young/middle aged adult

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17
Q

What are the two differentiated types of thyroid cancer?

A

Follicular and papillary

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18
Q

What is the most common type of thyroid cancer?

A

Papillary

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19
Q

Which type of differentiated thyroid cancer typically presents earlier (i.e. in adults aged 30-40, rather than 50)?

A

Papillary

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20
Q

Describe the typical spread of a papillary thyroid cancer?

A

To regional lymph nodes

21
Q

Describe the typical spread of a follicular thyroid cancer?

A

Haematogenously to the lung, brain and bone

22
Q

What are the two main non-differentiated types of thyroid cancer?

A

Medullary and anaplastic

23
Q

Cervical lymphadenopathy is a common presentation of which type of thyroid cancer?

A

Papillary

24
Q

What surgical procedure is required to treat papillary thyroid cancer?

A

Total thyroidectomy +/- node excision

25
Q

Which thyroid tumour may show an ‘Orphan Annie nuclei’ on histology?

A

Papillary carcinoma

26
Q

Once proven to be a carcinoma, how are follicular thyroid cancers treated?

A

Total thyroidectomy

27
Q

If patients experience airway obstruction after thyroid surgery, what is the best management option?

A

Remove their sutures to allow evacuation of the clot

28
Q

Following thyroid surgery, it is important to monitor the levels of which electrolyte?

A

Calcium

29
Q

Calcium should be replaced following thyroid surgery if it is below what value?

A

2mmol/L

30
Q

When should IV calcium be given following thyroid surgery?

A

If the calcium level is < 1.8mmol/L or if the patient is symptomatic of hypocalcaemia

31
Q

What medication should patients with a differentiated thyroid cancer be continued on post-surgery?

A

Levothyroxine

32
Q

In patients who have undergone a subtotal or total thyroidectomy for a differentiated thyroid cancer, what investigation is performed 3-6 months post-operatively?

A

Whole body iodine scan

33
Q

Thyroxine treatment must be stopped how long before undergoing a whole body iodine scan?

A

4 weeks

34
Q

What is used as a tumour marker for differentiated thyroid cancer?

A

Thyroglobulin

35
Q

How often should thyroglobulin levels be measured in individuals who have undergone surgery for differentiated thyroid cancer?

A

6 monthly for the first 5 years, annually for the next 5 years

36
Q

Undergoing thyroid remnant ablation therapy comes with an increased risk of developing what condition in the future?

A

Acute myeloid leukaemia

37
Q

Recurrence of a differentiated thyroid cancer is most likely to occur within what timeframe?

A

The first two years

38
Q

Which type of thyroid cancer occurs in the elderly and is usually very aggressive, with death often occurring within 6 months of diagnosis?

A

Anaplastic carcinoma

39
Q

What treatment options are available for anaplastic thyroid carcinoma?

A

Palliative radio and chemotherapy

40
Q

Where do medullary thyroid carcinomas arise from?

A

Parafollicular C cells

41
Q

What is used as a tumour marker for medullary thyroid carcinoma?

A

Calcitonin

42
Q

70% of cases of medullary thyroid carcinoma are sporadic- these are usually seen in who?

A

Adults aged 40-60

43
Q

Around 20% of cases of medullary thyroid cancer are familial- in what pattern is this inherited?

A

Autosomal dominant

44
Q

Where do medullary thyroid cancers metastasise to?

A

Regional lymph nodes, lung, liver and bone

45
Q

Medullary thyroid carcinoma can be associated with which inherited cancer syndromes?

A

MEN2A and MEN2B

46
Q

What is the treatment of choice for medullary thyroid carcinoma?

A

Total thyroidectomy

47
Q

Which type of thyroid cancer often arises in patients who have Hashimoto’s thyroiditis?

A

B cell non-Hodgkin’s lymphoma

48
Q

What is the treatment of choice for B cell non-Hodgkin’s lymphoma of the thyroid?

A

Radiotherapy

49
Q

Psammoma bodies are a histological feature of which type of thyroid cancer?

A

Papillary carcinoma

Gen Surg (Breast and Thyroid) (8 decks)

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