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Endocrine Fellowship Board Review > Thyroid/Thyroid cancer > Flashcards

Thyroid/Thyroid cancer Flashcards

1
Q

ATA nodule criteria for biopsy

A

high - 1cm
intermediate - 1cm
low - 1.5cm
very low - 2.0cm

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2
Q

TR nodule criteria for biopsy

A

TR 3 - 2.5cm
TR 4 - 1.5cm
TR 5 - 1.0cm

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3
Q

which Bethesda do we send for Thyroseq

A

Bethesda 3,4,5

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4
Q

Bethesda categories

A 
1 - nondiagnostic
2- benign
3 - AUS/FLUS
4 - follicular neoplasm
5 - suspicious
6 - malignant
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5
Q

malignancy risk in high suspicion nodules

A

70-90%

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6
Q

malignancy risk in intermediate suspicion nodules

A

10-20%

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7
Q

malignancy risk in low suspicion nodules

A

5-10%

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8
Q

malignancy risk in very low suspicion nodules

A

<3%

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9
Q

malignancy risk in benign nodules

A

< 1%

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10
Q

high risk US features

A 
microcalcification
irregular margin
taller than wide
ETE
interrupted rim calcification
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11
Q

malignancy risk of AUS/FLUS (Bethesda 3)

A

5-15%

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12
Q

malignancy risk of follicular neoplasm (Bethesda 4)

A

15-30%

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13
Q

malignancy risk of benign nodule (Bethesda 2)

A

0-3%

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14
Q

which Bethesda category is Hurthle cell neoplasm

A

Bethesda 4

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15
Q

repeated nondiagnostic FNA with high risk features

A

surgery or close US observation

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16
Q

pathologic criteria for sufficient thyroid FNA

A

6 groups of well-visualized follicular cells, each containing at least 10 well-preserved epithelial cells

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17
Q

malignancy risk in nondiagnostic samples

A

low

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18
Q

appropriate operation for indeterminant thyroid nodules

A

lobectomy

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19
Q

high suspicion nodule with negative FNA

A

repeat FNA within 12 months

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20
Q

intermediate nodules with negative FNA

A

repeat US 12-24 months with repeat FNA if > 50% volumetric growth

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21
Q

very low suspicion nodule with negative FNA

A

repeat US 24 months

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22
Q

risk of thyroid cancer after 2 negative FNA

A

essentially 0%

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23
Q

risk of false negative FNA

A

3%

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24
Q

what % of adults have thyroid nodules

A

50%

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25
Q

recommendation for thyroid nodules with suspected iodine deficiency

A

150 mcg daily iodine

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26
Q

management of thyroid nodules > 4cm

A

symptomatic - surgery
FNA
negative FNA - surgery or follow

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27
Q

thyroid nodule discovered during pregnancy

A

FNA if euthyroid or hypothyroid

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28
Q

PTC diagnosed during pregnancy

A 
if substantial growth or e/o lymph nodes - surgery
if stable (ie no growth), surgery after delivery
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29
Q

suspicious lymph node size criteria for FNA

A

8-10mm in SHORTEST dimension

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30
Q

absolute criteria of total thyroidectomy

A

thyroid cancer > 4cm
gross ETE
clinically apparent metastatic disease to nodes or distant sites

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31
Q

surgery for 1-4cm thyroid cancers

A

lobectomy or total thyroidectomy

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32
Q

therapeutic central neck dissection for which patients

A

clinically involved central nodes

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33
Q

prophylactic central neck dissection (ipsilateral or bilateral) should be considered in which patients

A

PTC with no clinical nodes who have advanced primary tumors (T3 or T4), or clinically involved lateral neck nodes

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34
Q

who does NOT need prophylactic central neck dissection

A

small (T1 or T2) tumors, noninvasive, clinically node-negative PTC, and for most follicular cancers

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35
Q

who should have therapeutic lateral neck lymph node dissection

A

ONLY biopsy-proven metastatic lateral cervical adenopathy

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36
Q

surgery for most follicular carcinomas

A

lobectomy

37
Q

role of RAI ablation of remaining lobe in lieu of completion thyroidectomy

A

not recommended

38
Q

diurnal pattern of TSH

A

highest values in late afternoon/evening

39
Q

binding globulins for thyroid T4/T3

A

TBG
transthyretin
albumin

40
Q

what percentage of T4 and T3 are bound

A

99.7 % +

41
Q

two different assays for free hormone testing

A 
analogue (cheaper, easier)
equilibrium dialysis (not affected by serum binding proteins)
42
Q

deiodinase D1 converts T4 to T3 in which organs

A

liver, kidney

43
Q

deiodinase D2 converts T4 to T3 in which organ

A

brain

44
Q

reverse T3 (RT3) affinity for the T3 receptor

A

100x less than T3

45
Q

major disorders of thyroid hormone binding proteins

A

pregnancy
estrogen use
congenital TBG excess
familial dysalbuminemic hyperthyroxinemia

46
Q

what is familial dysalbuminemic hyperthyroxinemia

A

inherited disorder in which albumin has enhanced affinity for T4, resulting in increased TOTAL T4 but not T3

47
Q

role of T3 resin uptake measurement

A

helps distinguish protein binding disorders from true thyroid disease (inversely proportional to the protein binding capacity)

48
Q

t3 resin uptake in hyperthyroidism

A

high

49
Q

t3 resin uptake in hypothyroidism

A

low

50
Q

two conditions where thyroglobulin can be useful

A

thyroid cancer

thyroiditis

51
Q

effect of biotin on thyroid function tests

A

low TSH
high T4
looks like hyperthyroidism

52
Q

when to suspect HAMA (heterophile ab) interference

A

abnormal TFTs that don’t fit clinical scenario

53
Q

indications to treat subclinical hyperthyroidism

A 
age > 65 years
TSH <0.1
symptomatic
bone disease/afib
0.1-0.4 can be considered for therapy
54
Q

when to repeat thyroid US for 1cm very low risk thyroid nodules

A

either no follow up, or 2 years

55
Q

initial surgical procedure for differentiated thyroid cancer with tumor > 4cm?

A

total thyroidectomy

56
Q

initial surgical procedure with clinically apparent nodal mets, distant mets, or with gross extrathyroidal extension?

A

total thyroidectomy

57
Q

initial surgical procedure for thyroid cancer > 1cm and < 4cm without ETE, and without nodal mets?

A

either lobectomy or total thyroidectomy

58
Q

which patients should have therapeutic central compartment dissection?

A

pts with clinically involved central nodes

59
Q

which patients should be considered for prophylactic central-compartment neck dissection (ipsilateral or bilateral)?

A

PTC with clinically uninvolved central compartment nodes BUT T3 or T4 tumors or clinically involved lateral neck nodes

60
Q

which patients do NOT need prophylactic central neck dissection?

A

small tumors (T1, T2), noninvasive, node-negative PTC and most follicular cancers

61
Q

which patients should get lateral neck lymph node dissection?

A

biopsy proven nodal metastasis

62
Q

which patients should be offered completion thyroidectomy?

A

those for whom total thyroidectomy would have been recommended had the diagnosis been available before initial surgery (ie gross ETE, nodal involvement)

63
Q

T1a

A

tumor < 1cm, without ETE

64
Q

T1b

A

1-2cm, without ETE

65
Q

T2

A

2-4cm, without ETE

66
Q

T3

A

> 4cm in thyroid, OR

any size tumor with minimal ETE (sternohyoid muscle, perithyroid soft tissues)

67
Q

T4a

A

tumor of any size extending thyroid capsule to invade subQ tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve

68
Q

T4b

A

tumor of any size involving prevertebral fascia or encasing carotid artery or mediastinal vessels

69
Q

N0

A

no metastatic nodes

70
Q

N1a

A

mets to level 6 nodes

71
Q

N1b

A

mets to nodes in all other levels

72
Q

M0

A

no distant mets

73
Q

M1

A

distant mets

74
Q

patient with thyroid cancer on levothyroxine withdrawal for treatment of thyroid cancer who develops nausea, confusion, lethargy, weakness, headache

A

check sodium level

75
Q

number and size of micrometastases that still qualify as low-risk thyroid cancer

A

< or = 5, less than 0.2mm in largest dimension

76
Q

TSH goal for low-risk thyroid cancers

A

0.5-2.0

77
Q

TSH goal for intermediate-risk thyroid cancers

A

0.1-0.5

78
Q

TSH goal for high-risk thyroid cancers

A

< 0.1

79
Q

most common cause of thyroid storm in a patient already on thionamide tx

A

medication noncompliance

80
Q

rising calcitonin/CEA in MTC patient with negative imaging – where to look for mets

A

Liver MRI with contrast
MRI spine
FDG PET/DOTATATE can be considered but not used routinely

81
Q

2 ways of differentiating destructive thyroiditis from Graves’

A

uptake/scan, serum thyroglobulin

82
Q

Graves’ pt gets RAI, has worsening hyperthyroidism the following week. Likely diagnosis?

A

destructive thyroiditis due to RAI

83
Q

Graves’ pt gets RAI, then develops hyperthyroidism again a month later. Likely diagnosis?

A

recurrent Graves’ due to insufficient RAI dose

84
Q

Graves’ pt gets RAI, then becomes more hyperthyroid after. How to differentiate between thyroiditis and recurrent Graves’?

A

uptake/scan

85
Q

Pt with PTC has rising Tg level, negative Tg Abs, and negative whole body scan and neck US. Next imaging test?

A

PET/CT

86
Q

treatment for pregnant female with substantial volume of residual cancer

A

surgery in 2nd trimester

87
Q

treatment for pregnant female with small thyroid cancer

A

surgery after delivery

88
Q

most common immune checkpoint inhibitor side effect

A

hypothyroidism

Endocrine Fellowship Board Review (11 decks)

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