Thyroid/Para Flashcards
Bethesda 1
Nondiagnostic (ROM up to 20%)
Rpt FNA accurate 60-80%
Bethesda 2
Benign (2-7%)
Follow up in 6 months with US
Bethesda 3
AUS (15-35%)
Higher if cellular atypica
Bethesda 4
Follicular neoplasm
Follicular with oncocytic features higher ROM
20-40%
Bethesda 5
Suspicious for malignancy
65-85%
Usually papillary
Papillary > 1 cm indications for total thyroid
Bilobar disease
>4 cm
Older age
Male
Positive LN
Radiation
Extrathyroidal extension
Distant mets
Post lobectomy indications for completion?
> 4 cm
ETE
N1a disease (not required for 5 nodes with less than 2 mm deposits)
Vascular invasion
Positive margins
Contralateral disease
Total thyroidectomy followup
6-12 months US, then annual US
Tg, TSH at 6-12 weeks
Measure Tg, Tg antibody and TSH annually
Follicular indications for completion thyroidectomy?
- Widely invasive
- Encapsulated angioinvasive (>4 vessels)
Minimally invasive, < 4 vessels NIFTP and follicular adenoma DO NOT need completion
Oncocytic carcinoma
Indications for total same as follicular
Medullary thyroid carcinoma management
- > 1 cm total thyroid with level 6
- Ipsilateral or bilateral lateral neck for clinically or radiologically positive nodes
- Prophylactic lateral neck for high volume disease in thyroid or central neck
- < 1 cm still needs total thyroid with central neck
Medullary MEN2 B treatment?
Thyroidectomy by age 1
Para as well if hypercalcemic
Medullary MEN2A treatment?
Thyroidectomy with neck diss as needed by age 5
Targeted therapy medullary thyroid cancer?
TKI (Vandetanib)
Selpercatinib for RET
TSH levels after total
High risk < 0.1
Low risk 0.1-0.5