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1. Endocrine > Thyroid tumours > Flashcards

Thyroid tumours Flashcards

1
Q

Name a benign thyroid tumour?

A

follicular adenoma

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2
Q

What are follicular adenomas comprised of?

A

neoplastic thyroid follicules

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3
Q

What can follicular adenomas lead to? Why?

A

thyrotoxicosis

they can secrete T3/T4

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4
Q

What are the genetic mutations that predispose to follicular adenomas?

A

ras
P1K3CA
TSHR pathway mutations

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5
Q

What are the symptoms of folliclar adenomas?

A

usually an incidental finding

if large –> can cause dysphagia

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6
Q

What is the most common kind of malignany thyroid cancer? Rank them

A

Papillary
Follicular
Medullary
Anaplastic

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7
Q

What can predispose to thyroid carcinomas?

A

ionising radiation

iodine deficiency

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8
Q

What are the genetic mutations that predispose to papillary carcinomas?

A

Ras
BRAF
RET
NTR1 rearrangement

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9
Q

What are the genetic mutations that predispose to follicular carcinomas?

A

P13K/AKT
ras
Pax 9
PPARyl translocation

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10
Q

What are the genetic mutations that predispose to medullary carcinomas?

A

MEN2

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11
Q

What are the genetic mutations that predispose to anaplastic carcinomas?

A

MEN2
p53
B-catenin

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12
Q

Describe papillary carcinomas?

A

solitary nodule often calcified with plasmalemma bodies

associated with Hashimotos thyroiditis

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13
Q

How do papillary carcinomas normally present?

A

metastesise to lymph nodes (often cervical) and present there

if large: 
dysphagia 
hoarseness
cough
dyspnoea
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14
Q

What do papillary carcinomas secrete?

A

thyroglobulin - as they are TSH driven and take up iodine

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15
Q

What is the prognosis of papillary carcinomas?

A

95% at 10 years

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16
Q

Describe follicular carcinomas?

A

single painless nodule that slowly enlarges

17
Q

How can follicular carcinomas spread?

A

haematological

18
Q

Who is more susceptible to follicular carcinomas? Females or males? old or young?

A

females

older age

19
Q

In what areas is the incidence of follicular carcinomas very high?

A

areas of iodine deficiency

20
Q

What is the prognosis of follicular carcinomas?

A

minimal spread - 90% at 10years

widespread - 50% at 10years

21
Q

Describe medullary carcinomas?

A

derived from C cells and associated with amyloid deposition

22
Q

What are the 2 types of medullary carcinoma? How do they present?

A 
sporadic = solitary nodule
familial = bilateral/multicentric/C cell hyperplasia
23
Q

What can medullary carcinomas lead to?

A

paraneoplastic syndromes

  • diarrhoea - VIP production
  • cushings - ACTH production
24
Q

Describe anaplastic carcinomas?

A

undifferentiated, rapid growth with involvement of neck structures

25
Q

What is the prognosis of medullary carcinomas?

A

70-80% at 5 years

26
Q

What population presents with anaplastic carcinomas?

A

older people

27
Q

How is the treatment for thyroid carcinomas assessed?

A

ultrasound guided fine needle aspiration

excision biopsy of lymph nodes

28
Q

What is the scoring system to assess thyroid cancers?

A 
AMES
Age
Metasteses
Extent of primary tumour
Size of primary tumour
29
Q

What is the criteria for an AMES low risk?

A

younger patient <40/50 with no metastasis
older patient with papillary lesion or non invasive follicular lesion and no metastesise
tumour <5cm

30
Q

What is the criteria for an AMES high risk?

A

all patients with distant metastasis

31
Q

What is the treatment for AMES low risk?

A

thyroid lobectomy with isthmuscetomy

32
Q

What is the treatment for AMES high risk?

A

subtotal thyroidectomy

total thyroidectomy

33
Q

What is the treatment if there is nodal involvement?

A

lymph node surgery plus thyroidectomy etc

34
Q

What should all patients recieve after thyroid surgery?

A

T4 or T3
and check calcium levels - IV Ca if <1.8
whole body iodine scan should be performed 3-6months post op (if undergone a thyroidectomy)

35
Q

When do T3 and T4 need to be stopped before a whole body iodine scan?

A 
T4 = 4 weeks prior
T3 = 2 weeks
36
Q

Describe thyroid remnant ablation?

A

pre treated with rhTSH. given 2/3 GBq capsules of 1-131
after completion, patients discharged on T4
aim is to surpress T4 <0.1 mU/l and fT4 below 25

37
Q

Why is thyroid remnant ablation given?

A

if there is any leftover thyroid tissue that the surgeon was not able to remove during the total thyroidectomy

1. Endocrine (32 decks)

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