Thyroid/Para Flashcards

1
Q

Bethesda 1

A

Nondiagnostic (ROM up to 20%)
Rpt FNA accurate 60-80%

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2
Q

Bethesda 2

A

Benign (2-7%)
Follow up in 6 months with US

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3
Q

Bethesda 3

A

AUS (15-35%)
Higher if cellular atypica

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4
Q

Bethesda 4

A

Follicular neoplasm
Follicular with oncocytic features higher ROM
20-40%

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5
Q

Bethesda 5

A

Suspicious for malignancy
65-85%
Usually papillary

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6
Q

Papillary > 1 cm indications for total thyroid

A

Bilobar disease
>4 cm
Older age
Male
Positive LN
Radiation
Extrathyroidal extension
Distant mets

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7
Q

Post lobectomy indications for completion?

A

> 4 cm
ETE
N1a disease (not required for 5 nodes with less than 2 mm deposits)
Vascular invasion
Positive margins
Contralateral disease

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8
Q

Total thyroidectomy followup

A

6-12 months US, then annual US
Tg, TSH at 6-12 weeks
Measure Tg, Tg antibody and TSH annually

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9
Q

Follicular indications for completion thyroidectomy?

A
  • Widely invasive
  • Encapsulated angioinvasive (>4 vessels)
    Minimally invasive, < 4 vessels NIFTP and follicular adenoma DO NOT need completion
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10
Q

Oncocytic carcinoma

A

Indications for total same as follicular

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11
Q

Medullary thyroid carcinoma management

A
  • > 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
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12
Q

Medullary MEN2 B treatment?

A

Thyroidectomy by age 1
Para as well if hypercalcemic

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12
Q

Medullary MEN2A treatment?

A

Thyroidectomy with neck diss as needed by age 5

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13
Q

Targeted therapy medullary thyroid cancer?

A

TKI (Vandetanib)
Selpercatinib for RET

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14
Q

TSH levels after total

A

High risk < 0.1
Low risk 0.1-0.5

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15
Q

Prep for RAI

A

Allow TSH >30 (3-6 weeks after surgery)
0r 2 doses of rTSH
Iodine free diet 2 weeks

16
Q

TIRADS?

A

1benign- score 0-1
2 not suspicious- score 2 ( no FNA)
3- score 3 mildly suspicious (biopsy >2.5, observe >1.5)
4- score 4-6(biopsy >1.5, observe >1)
5- >7 ( biopsy >1)

17
Q

TIRADS markers?

A

Composition (0-2)
Echogenecity (0-3)
Size (0 or 3)
Margins (0-3)
Echogenic foci(0-3)

18
Q

Medullary cancer calcitonin level for distant met imaging?

A

> 500

19
Q

WHO 2022 classification of thyroid cancers?

A

Follicular carcinoma
Encapsulated invasive follicular variant of papillary
Papillary
Oncocytic
Medullary
Follicular derived carcinomas, high grade
Anaplastic

20
Q

Genetic mutations in thyroid cancers?

A

Papillary (MAPK pathway, BRAF 60%)
Follicular (RAS 66%, nras most common)
Hurthle (BRAF and RAS rare, high mitochondrial DNA mutations)
Medullary (>95% RET)
Anaplastic (TP53 and TERT more common)

21
Q

PET avid thyroid nodule malignancy rate?

A

30-40%

22
Q

Thyroid molecular tests ?

A

Affirma (binary, benign or suspicious)
Thyroseq ( mutation specific results)

23
Q

Rate of completion thyroidectomy after initial lobectomy for DTC?

A

10-20% in 10 years

24
Q

ATA high risk features?

A

Extrathyroidal extension
LN > 3cm
Incomplete resection
Distant mets

25
Q

ATA intermediate risk features?

A

Vascular invasion
>5 involved nodes
Aggressive histology
Minor ETE

26
Q

ATA low risk

A

Intrathyroidal DTC
<5 LN wiht micromets

27
Q

Thyroglobulin levels concerning for recurrence?

A

Stimulated Tg > 10
1-10 can be treated with TSH suppression

28
Q

Parathyroidectomy indications in asymptomatic patients?

A

> 1mg above normal
Age <50
GFR < 60
Osteoporosis
Nephrocalcinosis

29
Q

Medullary carcinoma targeted therapy?

A

RET inhibitors (Selpercatinib)