Thyroid - Nodules Flashcards by Jane Keery

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

Thyroglossal cyst

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How is a thyroglossal cyst treated?

Surgical excision (Sistrunk procedure)

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

Males, children and those aged > 60

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What are the two major risk factors for thyroid cancer?

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

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

Serum calcitonin

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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?

24h urinary catecholamines

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

To exclude a phaeochromocytoma

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

Ultrasound

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

Cold

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

FNA and cytology

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Why do all follicular neoplasms require surgery?

Because it is impossible to differentiate between adenomas and carcinomas

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What differentiates a follicular carcinoma from a follicular adenoma?

Capsular invasion

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What is the most common benign thyroid tumour?

Follicular adenoma

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

Toxic follicular adenoma

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

Thyroid lobectomy

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Describe the typical presentation of a thyroid cancer?

A solitary thyroid nodule in a young/middle aged adult

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What are the two differentiated types of thyroid cancer?

Follicular and papillary

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What is the most common type of thyroid cancer?

Papillary

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

Papillary

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Describe the typical spread of a papillary thyroid cancer?

To regional lymph nodes

Describe the typical spread of a follicular thyroid cancer?

Haematogenously to the lung, brain and bone

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

Medullary and anaplastic

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

Papillary

What surgical procedure is required to treat papillary thyroid cancer?

Total thyroidectomy +/- node excision

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

Papillary carcinoma

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

Total thyroidectomy

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

Remove their sutures to allow evacuation of the clot

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

Calcium

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

2mmol/L

When should IV calcium be given following thyroid surgery?

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

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

Levothyroxine

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

Whole body iodine scan

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

4 weeks

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

Thyroglobulin

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

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

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

Acute myeloid leukaemia

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

The first two years

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

Anaplastic carcinoma

What treatment options are available for anaplastic thyroid carcinoma?

Palliative radio and chemotherapy

Where do medullary thyroid carcinomas arise from?

Parafollicular C cells

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

Calcitonin

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

Adults aged 40-60

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

Autosomal dominant

Where do medullary thyroid cancers metastasise to?

Regional lymph nodes, lung, liver and bone

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

MEN2A and MEN2B

What is the treatment of choice for medullary thyroid carcinoma?

Total thyroidectomy

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

B cell non-Hodgkin's lymphoma

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

Radiotherapy

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

Papillary carcinoma