Thyroid Nodules and Cancer Flashcards
What is a thyroid nodule?
1 - malignant mass that forms in the thyroid
2 - hyperplasia of thyroid cells
3 - hypertrophy of thyroid cells
2 - hyperplasia of thyroid cells
- not normally cancerous but can become malignant
What % of adults in the UK have thyroid nodules?
1 - 0.4 - 0.7%
2 - 4-7%
3 - 40-70%
2 - 4-7%
- highest incidence in men >60 y/o
4-7 % of adults in the UK have thyroid nodules. What % of these become malignant?
1 - 0.5 - 1.0%
2 - 5-10%
3 - 15-30%
4 - >75%
2 - 5-10%
Are women or men more likely to develop thyroid nodules?
- females
Although thyroid nodules are normally benign, there are occasions that are concerning. Which of the following is NOT a concern for a thyroid nodules?
1 - >65 y/o
2 - single nodule getting bigger
3 - family history of thyroid cancer
4 - previous radiation to neck
5 - stridor
6 - cervical lymphadenopathy
7 - unexplained hoarseness
8 - weight loss
8 - weight loss
If we are suspicious about a thyroid nodule, we need to do the CRP (triple assessment). Which one of this is not part of this?
1 - clinical examination/history
2 - class II thyroids exam
3 - radiology
4 - pathophysiology
2 - class II thyroids exam
When we measure bloods in a patient with a thyroid nodule, which of the following is the least important?
1 - thyroid stimulating hormone
2 - thyroxine (T4)
3 - triiodothyronine (T3)
4 - reverse T3
4 - reverse T3
In hyperthyroidism, what would we expect to see in TSH, T3 and T4?
- TSH is low or normal
- T3 and T4 are high
In hypothyroidism, what would we expect to see in TSH, T3 and T4?
- TSH is high
- T3 and T4 are low
If someone has a thyroid nodule, what is often the first line imaging that is used?
1 - ultrasound
2 - CT scan
3 - PET scan
4 - iodine 123 scan
1 - ultrasound
If someone has a thyroid nodule and they have hyperthyroidism, what scan do they need?
1 - ultrasound
2 - CT scan
3 - PET scan
4 - iodine 123 scan
4 - iodine 123 scan
- iodine would be found in high levels in the nodule
- this is called a hot nodule
If a patient has a nodule but is hypothyroidism, what can be done?
1 - surgery
2 - iodine therapy
3 - levothyroxine
4 - Carbimazole or Propylthiouracil
3 - levothyroxine
If a patient has a nodule but is euthyroid, we need to identify if a nodule is dominant or is just diffusely swollen. If it is a dominant nodule we would do 3 of the following, which one is incorrect?
1 - fine needle aspiration biopsy
2 - ultrasound
3 - iodine 123 scan
4 - FDG-PET
3 - iodine 123 scan
Which of the following is not a typical sign of hyperthyroidism?
1 - Nervousness
2 - Sweating
3 - Palpitations
4 - Fatigue
5 - Weight gain
6 - Diarrhoea
7 - Increased appetite
8 - Tachycardia
9 - Tremor
5 - Weight gain
- typically lose weight due to increased metabolism
Which of the following is not a typical sign of hypothyroidism?
1 - Weakness and lethargy
2 - Dry skin
3 - Slow speech
4 - Sensitivity to cold
5 - Constipation
6 - Weight loss
7 - Loss of appetite
8 - Memory impairment
6 - Weight loss
- normally weight gain due to lowered metabolism
If a patient has a nodule and is euthyroid they will require a fine needle aspiration biopsy guided by ultrasound. This can be analysed by cytology and scored out of 5 as in the image. What levels requires surgery based on the biopsy to confirm diagnosis?
1 - all
2 - >2
3 - >3
4 - 5 only
3 - >3
What is the gold standard for diagnosing a patient who has a nodule and is euthyroid?
1 - core biopsy
2 - ultrasound
3 - fine needle aspiration biopsy
4 - iodine 123 scan
3 - fine needle aspiration biopsy
- needs to be ultrasound guided
How many cases of thyroid cancer are there each year?
1 - 4
2 - 40
3 - 400
4 - 4000
4 - 4000
- approx 400 deaths
- deaths are mainly in older patients
What is the peak incidence of thyroid cancer in women?
1 - 20-30
2 - 44-49
3 - 50-70
4 - 70-74
2 - 44-49
- women are more likely to develop thyorid cancer
What is the peak incidence of thyroid cancer in men?
1 - 20-30
2 - 44-49
3 - 50-70
4 - 70-74
4 - 70-74
In patients with thyroid cancer, survival depends on 3 key factors. Which of the following is NOT one of these factors?
1 - age
2 - diabetes
3 - pathological subtype
4 - metastatic disease
2 - diabetes
- thyroid cancer is the only cancer where age is included in the TNM staging
There are 4 different types of thyroid cancer pathology. Which one of the following is NOT a subtype?
1 - papillary
2 - follicular
3 - medullary
4 - anaplastic
5 - carcinoma in-situ
5 - carcinoma in-situ
There are 4 different types of thyroid cancer pathology. Which one of the following is most common?
1 - papillary
2 - follicular
3 - medullary
4 - anaplastic
1 - papillary
- accounts for 50-60% of all thyroid cancers
- excellent prognosis if no metastasis
Papillary cancers are the most common cause of thyroid cancers. Which of the following is NOT true about these tumours?
1 - caused by RET and BRAF gene mutations
2 - linked with childhood ionising radiation
3 - contain high protein and DNA in their cells
4 - name comes from appearance like papillae (finger like projections)
3 - contain high protein and DNA in their cells
- they have LOW proteins and DNA and are called Orphan Annie Eye Nucleus
Follicular thyroid cancers are the 2nd most common type of thyroid cancer. Which of the following is NOT true about these cancers?
1 - linked with mutations in RAS (oncogene) and PTEN (tumour suppressor gene)
2 - develops from follicular cells, breaking-out of fibrous capsule
3 - invade near by blood vessels and lymph nodes
4 - spread to the lungs, liver, bone, and brain
5 - cannot be distinguished from adenocarcinomas
3 - invade near by blood vessels and lymph nodes
- do not typically spread to lymph nodes
Medullary thyroid cancer grows from a specific cell type and account for approx 10% of all thyroid cancers. What do these tumours originate from?
1 - C cells
2 - B cells
3 - follicular cells
4 - follicular capsule
1 - C cells
- C cells produce calcitonin that controls plasma Ca2+
- these tumours have a good prognosis
Anaplastic tumours have odd cell appearance, which is where they get their name from. Which of the following is NOT true about these tumours?
1 - they are rare
2 - have a poor prognosis
3 - locally invade
4 - always cause hyperthyroidism
4 - always cause hyperthyroidism
When we decide which patients need treatment there are a number of specific cases that do. Which of the following would NOT need surgery?
1 - Cancer
2 - Pressure symptoms (stridor, tracheal deviation)
4 - Grave’s disease
5 - Cosmesis
6 - Hashimoto’s thyroiditis
7 - Diagnostic uncertainty
6 - Hashimoto’s thyroiditis
- this would be treated with levothyroxine
The following are different types of surgery. If a patient has a solitary toxic nodule with diagnostic uncertainty, which surgery would generally be performed?
1 - hemi-thyroidectomy
2 - total thyroidectomy
3 - radioiodine
4 - Carbimazole or Propylthiouracil
1 - hemi-thyroidectomy
The following are different types of surgery. If a patient has graves disease, proven cancer and/or multi nodular goitre, which surgery would generally be performed?
1 - hemi-thyroidectomy
2 - total thyroidectomy
3 - radioiodine
4 - Carbimazole or Propylthiouracil
2 - total thyroidectomy
In thyroid surgery blood vessels can be damaged. Which 2 of the following could be damaged leading to oedema and obstruction of the upper airway?
1 - external carotid artery
2 - superior thyroid artery
3 - inferior thyroid artery
4 - right subclavian artery
2 - superior thyroid artery
3 - inferior thyroid artery
In thyroid surgery nerves can be damaged. Which 2 of the following could be damaged leading to hoarse voice, stridor or even laryngeal obstruction?
1 - left recurrent laryngeal nerve
2 - vagus nerve
3 - superior laryngeal nerve
4 - right recurrent laryngeal
1 - left recurrent laryngeal nerve
4 - right recurrent laryngeal
When removing the thyroid gland in surgery we must ensure we do not remove what?
1 - C cells
2 - parathyroid
3 - pituitary gland
4 - superior thyroid artery
2 - parathyroid
- only need one to function
