Thyroid nodules (E&M) Flashcards
Define thyroid nodules.
Abnormal growths within the thyroid glands - they are usually non-functioning
Which groups do thyroid nodules happen more commonly in? (2)
- F>M
- incidence increases with age
What are some benign causes of thyroid nodules? (4)
- multinodular goitre
- Hashimoto’s thyroiditis
- thyroid adenoma
- thyroid cyst
What are types of thyroid cysts (benign thyroid nodules)? (3)
- colloid - overgrowths of normal thyroid tissue (most common type of thyroid nodules)
- simple - growths that are filled with fluid/partly solid and partly filled - pose low risk for cancer = monitored/biopsies if >2cm
- haemorrhagic
What are some malignant causes of thyroid nodules? (3+3)
- thyroid carcinoma:
- papillary carcinoma
- follicular carcinoma
- medullary carcinoma
- anaplastic carcinoma
- lymphoma
What are the three types of thyroid carcinoma (malignant thyroid nodules)?
- papillary carcinoma - most common, 30-40y
- follicular carcinoma - second most common, 30-60y
- medullary carcinoma
Where can papillary carcinoma metastasise to?
Cervical lymph nodes
What can you use as a tumour marker for papillary carcinoma?
Thyroglobulin
What do you see on light microscopy in papillary carcinoma?
Orphan Annie eyes
What is the prognosis of papillary carcinoma like?
Very good
When is follicular carcinoma more common?
In areas of low iodine and in women (30-60y)
Where does follicular carcinoma metastasise to?
Lung and bones
What can you use as a tumour marker for follicular carcinoma?
Thyroglobulin
What is medullary carcinoma?
Cancer of parafollicular cells, secretes calcitonin
What hereditary condition is medullary carcinoma a part of?
MEN-2 (Multiple Endocrine Neoplasia Type 2):
- medullary carcinoma
- parathyroid hyperplasia
- phaeochromocytoma
What are the risk factors for thyroid cancer? (4)
- radiation
- family Hx
- rapid enlargement/compression
- lymphadenopathy
What are some different types of neck lumps? (7)
- reactive lymphadenopathy - tender LNs, Hx of local infection/viral illness
-
lymphoma - rubbery and painless lymphadenopathy, B symptoms (fever, WL, night sweats), splenomegaly
- thyroid lymphoma linked with Hashimoto’s thyroiditis
- thyroid swelling - hypo/hyper/euthyroid Sx, moves upwards on swallowing
- thyroglossal cyst - mass that develops from tissues that remains after formation of thyroid gland
- pharyngeal pouch - part of pharyngeal lining herniates through pharyngeal wall
- branchial cyst - embryonic remnant
- carotid aneurysm
What are the clinical features of lymphoma (thyroid nodules)? (3)
- rubbery and painless lymphadenopathy
- B symptoms - fever, WL, night sweats
- splenomegaly
What are the clinical features of thyroid swelling (thyroid nodules)? (2)
- hyper/hypo/euthyroid symptoms
- lump moves upwards on eating
What are the clinical features of a thyroglossal cyst (thyroid nodules)? (4)
- age <20y
- midline
- moves upwards on protrusion of tongue
- painful if infected
What are the clinical features of a pharyngeal pouch? (7)
- older men
- not seen usually but if large, then midline mass
- gurgles on palpation
- dysphagia
- regurgitation
- aspiration
- chronic cough
What are the clinical features of a branchial cyst (thyroid nodules)? (4)
- oval, mobile, cystic mass
- between SCM and pharynx
- presents in early adulthood
- contains cholesterol crystals
What are the clinical features of carotid aneurysm (thyroid nodules)? (3)
- pulsatile
- lateral neck mass
- does not move on swallowing
How do most thyroid nodules present?
Asymptomatic
Which type of thyroid nodule is most likely to be malignant?
Single isolated nodule
What is a red flag for thyroid cancer?
Radiation to head or neck
What is the first-line imaging for thyroid nodules?
Ultrasonography to check for features of malignancy
What other investigation would we do if we suspect malignancy (thyroid nodules)?
Fine needle aspiration biopsy (alongside ultrasound)
What bloods do we do for thyroid nodules?
TFTs
What scan can we do for thyroid nodules?
Radioiodine uptake scan
What different results could there be of a radioiodine uptake scan? (5)
- Graves disease - diffuse uptake throughout enlarged gland
- toxic adenoma - single hot nodule
- toxic multinodular goitre - multinodular gland with single hot nodule, patchy uptake
- thyroid cancer - diffuse uptake with single cold nodule
- de Quervain’s (viral) thyroiditis - no uptake
How would Grave’s disease present on radioiodine uptake scan?
Diffuse uptake throughout enlarged gland
How would toxic adenoma present on radioiodine uptake scan?
Single hot nodule
How would toxic multinodular goitre present on radioiodine uptake scan?
Multinodular gland with single hot nodule + patchy uptake
How would thyroid cancer present on radioiodine uptake scan?
Diffuse uptake with single cold nodule
How would de Quervain’s (viral) thyroiditis present on radioiodine uptake scan?
No uptake
Describe the diagnostic flowchart for thyroid nodules.
- history and examination
- TSH + ultrasound of neck
- TSH subnormal –> thyroid scintigraphy
- functioning (hot) nodule = evaluation for hyperthyroidism (T3/4)
- non-functioning (cold) nodule OR if TSH normal/elevated –> criteria for FNA met? (suspicious nodule >1cm, large nodule >1.5-2cm, RFs for malignancy) –> if Y = FNA + cytology, if N = monitor with ultrasound
What is the main form of management for thyroid nodules?
Thyroid surgery
How do we manage papillary and follicular carcinoma (thyroid nodules)?
Total thyroidectomy followed by radioiodine to kill residual cells
After - give thyroxine and do yearly thyroglobulin levels check to detect early recurrent disease
How do we treat hyperthyroidism? (2)
- beta blockers
- anti-thyroid drugs (carbimazole)
