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Y2 - Endocrine > Thyroid Nodules > Flashcards

Thyroid Nodules Flashcards

1
Q

What are the two types of thyroid nodule?

A

Solitary thyroid nodule

Multi-nodular goitre

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2
Q

Are there more benign or malignant thyroid nodules?

A

95% benign

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3
Q

What are the types of benign solitary thyroid nodules?

A

Thyroid cyst
Colloid nodule
Benign follicular adenoma
Hyperplastic nodule

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4
Q

What are the types of malignant solitary thyroid nodules?

A 
Papillary thyroid carcinoma
Follicular thyroid carcinoma
Medullary thyroid carcinoma
Lymphoma
Anaplastic thyroid carcinoma
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5
Q

How would you tell if a nodule in the neck is in the thyroid or not?

A

Ask patient to swallow - if it moves it is in the thyroid

Pain is uncommon in thyroid nodules

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6
Q

What is pain usually caused by if present in a thyroid nodule?

A

Intra-thyroidal bleed into a cyst

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7
Q

What are risk factors for thyroid carcinomas?

A

Neck irradiation

Family history

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8
Q

What are the signs and symptoms of thyroid carcinomas?

A

Nodule in neck
Hoarseness
Enlarged cervical lymph nodes

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9
Q

What investigation is done for suspected thyroid carcinoma?

A

TSH levels
Ultrasound guided fine needle aspiration
May need core biopsy for lymphoma

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10
Q

What are the FNA classifications and what likelihood of carcinoma do they indicate?

A 
Thy1 - inadequate sampling
Thy2 - benign
Thy3 - atypical, more investigation needed
Thy4 - probably malignant
Thy5 - malignant
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11
Q

What factors indicate low risk of malignancy?

A

Aged <50
Tumour <4cm
TSH lower range of normal, baseline thyroglobulin

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12
Q

What factors indicate high risk of malignancy?

A

Aged >50
Tumour >4cm
TSH <1

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13
Q

What is the treatment for low risk patients?

A

Thyroid lobectomy

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14
Q

What is the treatment for high risk patients?

A

Total thyroidectomy

Consider radioactive iodine

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15
Q

In follow up of differentiated thyroid cancer, what substances should be at what level?

A

TSH - keep at lower end ofnkormal (0.4-4)

Thyroglobulin - keep low

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16
Q

What can be an indication of recurrence of thyroid caner?

A

Rising levels of thyroglobulin

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17
Q

What is a risk factor for thyroid lymphoma?

A

Background of autoimmune hypothyroidism

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18
Q

What is the usual presentation of a thyroid lymphoma?

A

Rapid onset of mass in the thyroid

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19
Q

What is the treatment for thyroid lymphoma?

A

Steroids
Chemotherapy
Radiotherapy

20
Q

What is medullary thyroid carcinoma?

A

A tumour of the parafollicular cells

21
Q

What is the tumour cell marker for medullary thyroid carcinomas?

A

Calcitonin (the substance c cells secrete)

22
Q

What are the types of medullary thyroid carcinoma?

A

Sporadic
Familial non-MEN
MEN
MEN2a

23
Q

What is MEN2a medullary thyroid carcinoma associated with?

A

Phaeochromocytoma
Hyperparathyroidism
Mucosal neuromas

24
Q

How can multi-nodular goitres function?

A

Over or underactive

Toxic

25
Q

What symptoms can be caused by compression of structures by a multi-nodular goitre?

A

Stridor

Chocking lying flat

26
Q

What are TSH levels in multi-nodular goitres?

A

Usually normal or slightly suppressed

27
Q

What signs of a multi-nodular goitre can be seen on CT scan?

A

Retrosternal extension

Tracheal compression

28
Q

What is the treatment for multi-nodular goitre?

A

Most can be left alone
Radioactive iodine if significant hyperthyroidism
Surgery if structural problem

29
Q

What are indications for surgery for multi-nodular goitre?

A

Lifestyle interfering symptoms
Possibility of cancer
Significant tracheal compression

30
Q

What are the two most common thyroid carcinomas?

A

Papillary (76%)

Follicular (17%)

31
Q

What does ‘differentiated thyroid carcinoma’ (DTC) refer to?

A

Papillary and follicular carcinomas

Both well differentiated and look very similar to normal histology

32
Q

How do DTCs function?

A

Take up iodine and secrete thyroglobulin

33
Q

What is the prognosis like for DTCs?

A

Very good

34
Q

What are risk factors for DTCs?

A

Exposure to radiation

No other strong associations

35
Q

What is the usual presentation of DTCs?

A

Palpable nodules

Some are incidental findings

36
Q

How do papillary thyroid cancers spread?

A

Lymphatics

Can spread by haematogenous spread to lungs, brain, liver, bone

37
Q

What condition is papillary thyroid cancer associated with?

A

Hashimoto’s thyroiditis (autoimmune hypothyroidism)

38
Q

How do follicular thyroid cancers spread?

A

Haematogenous route

Lymphatic spread is rare

39
Q

What are the surgical options for thyroid cancer?

A

Thyroid lobectomy with isthumectomy
Sub-total thyroidectomy
Total thyroidectomy

40
Q

What is the post-operative care for thyroid cancer?

A

Check calcium within 24 hours
Start calcium replacement if it falls below 2mmol/l
Discharge on T3 or T4

41
Q

When is whole body iodine scanning done?

A

In patients who have undergone sub-total or total thyroidectomy

42
Q

What is done before whole body iodine scanning and why?

A

TSH levels are raised with synthetic TSH to ensure sensitivity of the thyroid to iodine

43
Q

What is the purpose of whole body iodine scanning?

A

Will show any areas of thyroid cancer activity

44
Q

What is thyroid remnant ablation?

A

A treatment for thyroid cancer involving radiation that can ablate residual thyroid tissue to destroy microfoci that surgeons can’t see

45
Q

What are the side effects of thyroid remnant ablation?

A

Siladenitis (painful salivary glands)

Sore throat

Y2 - Endocrine (9 decks)

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