thyroid nodules & management

Question 1

what is the difference between a thyroid mass, nodules and lesion?

Answer 1

mass >4cm
nodule 1-4cm
lesion <1cm

Question 2

what do follicular cells ‘thyrocytes’ produce?

Answer 2

thyroglobulin

Question 3

what do para-follicular ‘C’ cells produce?

Answer 3

calcitonin

Question 4

what is the only thyroid function blood test that is routinely done before surgery for thyroid nodules?

Answer 4

TSH (calcitonin is also occasionally done when MTC is suspected)

Question 5

what is the scoring system for thyroid nodules?

Answer 5

Thy1 / Thy1c – Insufficient or Insufficient cystic
Thy2 / Thy2c – Non-neoplastic or Cystic
Thy3a [25% cancer] – Neoplasm possible (nuclear Atypia)
Thy3f [31% cancer] – Neoplasm possible (Follicular or oncocytic neoplasms)
Thy4 [80% cancer] – Suspicious of malignancy (unsuitable for Thy3a,Thy3f or Thy5)
Thy5 [98% cancer] – Malignant (tumour type should be clearly stated if possible)

Question 6

what is the usual treatment for a thy4/5 score?

Answer 6

hemi or total thyroidectomy (total for >4cm) + radioactive iodine

Question 7

what is the usual treatment for thy3a or thy3f

Answer 7

diagnostic hemi-thyroidectomy or repeat FNA

Question 8

what is the next step if a diagnostic hemi-thyroidectomy shows cancer?

Answer 8

surveillance, complete thyroidectomy + radioactive iodine

Question 9

what are the complications of thyroidectomy?

Answer 9

Seroma – Common & settles (<5%)
Superficial haematoma – Common & settles. Consider evacuation if large
Hypocalcaemia – Only after total thyroidectomy (parathyroid function)
Wound infection – Uncommon (<5%). If in doubt, give antibiotics
Scar – Abnormal Scarring uncommon (<5%). Body image/ Psychology affects QOL
Stridor – Deep haematoma causing laryngeal oedema. Rare (<1%)
RLN injury – Voice change & swallow problems. A spectrum
Chyle leak – Possible with Left Level VI lymph node dissection
Other nerve injuries – Neck dissections closer to the skull base are more risky