Thyroid Nodules + Cancer Flashcards
where are thyroid nodules more common?
in iodine-deficient areas
what would we order if a patient presents with a thyroid nodule? (2)
TSH + T4
ultrasound
what are 5 concerning characteristics of a thyroid nodule on ultrasound? (BICHM1)
Blood supply
Irregular margins
Complex cyst
Heterogenous echogenity
Microcalcifications
>1cm
what is one nodule called vs multiple nodules present?
toxic adenoma
toxic multinodular goiter
a patient presents with multiple nodules that are enlarged, asymmetric and firm. what are they likely experiencing?
toxic multinodular goiter
what lab values will we expect to see in a patient with toxic multinodular goiter? (2)
T3/T4 - normal or elevated
TSH - low
what’s the difference in a RAIU scan of a toxic adenoma vs a toxic multinodular goiter?
TMG is asymmetric
what diagnostic should we get if we think a patient has a toxic adenoma or toxic multinodular goiter?
FNA
what are 2 medications to help treat the symptoms of a toxic adenoma or toxic multinodular goiter?
propranolol
methimazole
what is the treatment for a toxic adenoma or TMG?
radioactive iodine therapy
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?
thyroidectomy
what is the most common AND least aggressive thyroid malignancy?
papillary thyroid carcinoma
what is important to remember about papillary thyroid carcinoma in older patients?
can be more aggressive and spread to trachea, neck muscles, and lungs
what increases the risk of papillary thyroid carcinoma?
exposure to neck radiation as a child
how does papillary thyroid carcinoma spread?
through lymphatics
more aggressive than papillary, secretes T4, and absorbed iodine well in RAIU scans
follicular thyroid carcinoma
where does follicular thyroid carcinoma usually metastasize? (3)
cervical lymph nodes
bones
lungs
can secrete calcitonin, prostaglandin, serotonin, ACTH, CRH, and CEA. this also metastasizes early in the disease process.
medullary thyroid carcinoma
what is mandatory to get done in a patient who may have medullary thyroid carcinoma, including their family members?
genetic analysis
where does medullary thyroid carcinoma metastasize early in the disease process? (2)
trachea
local/mediastinal lymph nodes
where does medullary thyroid carcinoma metastasize late in the disease process? (BALL)
Bone
Adrenals
Liver
Lungs
occurs in older patients and is the most aggressive thyroid cancer.
anaplastic thyroid carcinoma
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?
anaplastic thyroid carcinoma
where does anaplastic thyroid carcinoma usually metastasize early in the disease process?
local + distant sites
