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Endocrinology > Thyroid nodules basics > Flashcards

Thyroid nodules basics Flashcards

1
Q

What is a nodule?

A

Growth of abnormal tissue (Typically firm and palpable)

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2
Q

What is the difference between a thyroid nodule and small thyroid lesion

A
  • Thyroid nodules are >1cm
  • Small thyroid lesions are <1cm
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3
Q

What are some neck-specific consultation questions for thyroid nodules?

A

Lump size
Changes
Pain
Duration
Voice changes
Swallow changes

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4
Q

What structures need to be examined in suspected thyroid nodule?

A

Eyes
Neck and neck triangles
Thyroid gland
Tongue protuberances
Water swallow test

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5
Q

What are some features that predict malignancy?

A
  • New thyroid nodule age <20 or >50
  • Male
  • Nodule increasing in size
  • Lesion >4cm in diameter
  • History of head and neck irradiation
  • Vocal cord palsy
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6
Q

What are some blood tests required in suspected thyroid nodule?

A
  • TSH (If low, then unlikely to be cancer)
  • Calcitonin
  • Thyroglobulin
  • Thyroglobulin antibody
  • PTH
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7
Q

When should thyroglobulin be tested for in cases of surgery?

A

Pre and post operative
Negative thyroglobulin is only a sign that the tumour has been fully removed if pre-operative levels were high

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8
Q

What are some imaging techniques used in suspected thyroid malignancy?

A
  • Ultrasound (1st line)
  • Radioisotope scan - If TSH suppressed
  • CT - Used in local cancer invasion or advanced disease
  • Laryngoscopy - If vocal cord palsy
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9
Q

What is the ultrasound grading system for thyroid nodules?

A
  • U1 - Normal
  • U2 - Benign
  • U3 - Indeterminate
  • U4 - Suspicious
  • U5 - Malignant
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10
Q

What is the fine needle aspiration grading system used in thyroid nodules?

A
  • Thy1 - Non-diagnostic
  • Thy2 - Benign
  • Thy3 - Indeterminate
  • Thy4 - Suspicious
  • Thy5 - Malignant
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11
Q

What patients will undergo thyroid lobectomy with isthusectomy in case of thyroid nodule?

A
  • Papillary microcarcinoma
  • Minimally invasive follicular carcinoma with capsular invasion only
  • Patients in AMES low risk group
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12
Q

What are the indications of sub-total or total thyroidectomy in thyroid nodule formation?

A
  • DTC with extra-thyroidal spread
  • Bilateral multifocal DTC
  • DTC with distant metastases
  • DTC with nodal involvement
  • Patients in AMES high risk group
  • Thy5 >4cm = Total thyroidectomy
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13
Q

What are some complications of thyroidectomy?

A
  • Superficial haematoma - common and settles
  • Hypocalcaemia - Only after total thyroidectomy due to parathyroid function
  • Wound infection - Uncommon
  • Scar - Abnormal scarring uncommon
  • Stridor - Deep haematoma causing laryngeal haematoma
  • Nerve injury - Voice change and swallow problems
  • Chyle leak - Possible with left level VI lymph node dissection
  • Other nerve injury
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14
Q

What is performed in cases of macroscopic lymph node disease in metastatic thyroid malignancy?

A

Central compartment clearance and lateral lymph node sampling

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15
Q

What risk stratification method is used for post-operative risk stratification?

A
  • A - Age
  • M - Metastases
  • E - Extent of primary tumour
  • S - Size of primary tumour
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16
Q

Who would be AMES low risk?

A

Young patients (M<40, F<50) with no evidence of metastasis or an older patients with an intrathyroidal papillary lesion or minimally invasive follicular lesion and primary tumour <5cm, with no distant metastasis

17
Q

What is the 20 year survival rate for low-AMES patients?

A

99%

18
Q

Who would be AMES high risk?

A

Any patient with distant metastases, extrathyroidal disease in papillary cancer, significant capsular invasion with follicular carcionoma, primary tumour >5cm in older patients

19
Q

What is the 20 year survival rate for AMES high risk?

A

61%

20
Q

What will be performed post-operatively in thyroidectomy?

A
  • Calcium checked within 24 hours
  • Calcium replacement if corrected calcium below 2mmol/L
  • IV calcium for calcium levels <1.8mmol/L or if symptomatic (Shaky, hungry, heart symptoms)
  • Patient discharged on T3 or T4
21
Q

When would whole body iodine scanning be performed?

A

3-6 months after a sub-total or total thyroidectomy

22
Q

What is the purpose of whole body iodine scanning?

A

Low dose radioactive iodine is given and is scanned for, to show where there is thyroid tissue in the body (Metastasis)

23
Q

What used to be done about a patients T3 and T4 medication before whole body iodine scanning?

A
  • T3 and T4 used to have to be stopped as this would cause a reduction in TSH levels
  • TSH stimulates iodine uptake into the thyroid and stimulates T3 and T4 production
  • If TSH levels are low, then the radioactive iodine would not be taken up
24
Q

What is now done about a patients T3 and T4 medication before whole body iodine scanning?

A

They are given rhTSH injection which allows for transport of the radioisotope despite suppressed TSH levels

25
Q

What treatment can be performed on remnant thyroid tissue after thyroidectomy?

A

Thyroid remnant ablation

26
Q

What occurs in thyroid remnant ablation?

A

-Patients are admitted to an isolated, lead lined room with non-mains sewerage
-Anything taken in is classified as radioactive waste
-The patient is pre-treated with rhTSH and then a 2-3 GBq capsule of radioactive iodine (I-131)
-This aims to ablate residual thyroid tissue to destroy occult microfoci

27
Q

What are some forms of systemic anti-cancer therapies used in thyroid nodules?

A

Sorafenib and lenvatinib for patients with refractory DTC following radioactive iodine

28
Q
A

Endocrinology (42 decks)

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