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Endocrinology > Thyroid Nodules + Cancer > Flashcards

Thyroid Nodules + Cancer Flashcards

1
Q

where are thyroid nodules more common?

A

in iodine-deficient areas

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2
Q

what would we order if a patient presents with a thyroid nodule? (2)

A

TSH + T4
ultrasound

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3
Q

what are 5 concerning characteristics of a thyroid nodule on ultrasound? (BICHM1)

A

Blood supply
Irregular margins
Complex cyst
Heterogenous echogenity
Microcalcifications
>1cm

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4
Q

what is one nodule called vs multiple nodules present?

A

toxic adenoma
toxic multinodular goiter

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5
Q

a patient presents with multiple nodules that are enlarged, asymmetric and firm. what are they likely experiencing?

A

toxic multinodular goiter

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6
Q

what lab values will we expect to see in a patient with toxic multinodular goiter? (2)

A

T3/T4 - normal or elevated
TSH - low

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7
Q

what’s the difference in a RAIU scan of a toxic adenoma vs a toxic multinodular goiter?

A

TMG is asymmetric

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8
Q

what diagnostic should we get if we think a patient has a toxic adenoma or toxic multinodular goiter?

A

FNA

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9
Q

what are 2 medications to help treat the symptoms of a toxic adenoma or toxic multinodular goiter?

A

propranolol
methimazole

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10
Q

what is the treatment for a toxic adenoma or TMG?

A

radioactive iodine therapy

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11
Q

what is the treatment for a toxic adenoma or TMG, if we need to relieve pressure symptoms, for cosmetic indications, or for a patient with co-existing cancer?

A

thyroidectomy

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12
Q

what is the most common AND least aggressive thyroid malignancy?

A

papillary thyroid carcinoma

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13
Q

what is important to remember about papillary thyroid carcinoma in older patients?

A

can be more aggressive and spread to trachea, neck muscles, and lungs

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14
Q

what increases the risk of papillary thyroid carcinoma?

A

exposure to neck radiation as a child

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15
Q

how does papillary thyroid carcinoma spread?

A

through lymphatics

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16
Q

more aggressive than papillary, secretes T4, and absorbed iodine well in RAIU scans

A

follicular thyroid carcinoma

17
Q

where does follicular thyroid carcinoma usually metastasize? (3)

A

cervical lymph nodes
bones
lungs

18
Q

can secrete calcitonin, prostaglandin, serotonin, ACTH, CRH, and CEA. this also metastasizes early in the disease process.

A

medullary thyroid carcinoma

19
Q

what is mandatory to get done in a patient who may have medullary thyroid carcinoma, including their family members?

A

genetic analysis

20
Q

where does medullary thyroid carcinoma metastasize early in the disease process? (2)

A

trachea
local/mediastinal lymph nodes

21
Q

where does medullary thyroid carcinoma metastasize late in the disease process? (BALL)

A

Bone
Adrenals
Liver
Lungs

22
Q

occurs in older patients and is the most aggressive thyroid cancer.

A

anaplastic thyroid carcinoma

23
Q

a patient presents with a rapidly enlarging mass in a goiter and pressure symptoms like dysphagia and vocal cord paralysis. what are they likely experiencing?

A

anaplastic thyroid carcinoma

24
Q

where does anaplastic thyroid carcinoma usually metastasize early in the disease process?

A

local + distant sites

25
Q

a patient presents with a palpable, firm, non-tender thyroid nodule. what are they suspicious for?

A

thyroid malignancy/cancer

26
Q

what may a patient with medullary thyroid carcinoma present with?

A

flushing and persistent diarrhea

27
Q

what lab may be elevated in papillary and follicular thyroid carcinoma?

A

thyroglobulin

28
Q

what can medullary thyroid carcinoma cause?

A

Cushing syndrome

29
Q

what should be monitored regularly in a patient with medullary thyroid carcinoma?

A

calcitonin
CEA

30
Q

what imaging will help us diagnose a thyroid malignancy?

A

neck ultrasound + FNA

31
Q

what is used after a thyroidectomy for surveillance?

A

RAI scanning

32
Q

in which case will we do a lobectomy in a patient with a thyroid malignancy?

A

low risk patient with papillary malignancy < 1cm

33
Q

what is the treatment for all malignancies, except papillary < 1cm?

A

thyroidectomy

34
Q

what medication should be started immediately after a thyroidectomy?

A

levothyroxine

35
Q

a patient has a thyroidectomy. how should we be monitoring their calcium levels?

A

periodic bone density scan

36
Q

what treatment for thyroid malignancies, except papillary < 1cm, should be started 2-4 months after thyroidectomy?

A

iodine therapy

37
Q

what is the purpose of iodine therapy 2-4 months after a thyroidectomy?

A

ablation of thyroid remnant

38
Q

what patients have a worse prognosis if they have a papillary malignancy? (3)

A

males over 45
metastases
cold metastases

Endocrinology (17 decks)

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