Thyroid tumours

Question 1

Name a benign thyroid tumour?

Answer 1

follicular adenoma

Question 2

What are follicular adenomas comprised of?

Answer 2

neoplastic thyroid follicules

Question 3

What can follicular adenomas lead to? Why?

Answer 3

thyrotoxicosis

they can secrete T3/T4

Question 4

What are the genetic mutations that predispose to follicular adenomas?

Answer 4

ras
P1K3CA
TSHR pathway mutations

Question 5

What are the symptoms of folliclar adenomas?

Answer 5

usually an incidental finding

if large –> can cause dysphagia

Question 6

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

Answer 6

Papillary
Follicular
Medullary
Anaplastic

Question 7

What can predispose to thyroid carcinomas?

Answer 7

ionising radiation

iodine deficiency

Question 8

What are the genetic mutations that predispose to papillary carcinomas?

Answer 8

Ras
BRAF
RET
NTR1 rearrangement

Question 9

What are the genetic mutations that predispose to follicular carcinomas?

Answer 9

P13K/AKT
ras
Pax 9
PPARyl translocation

Question 10

What are the genetic mutations that predispose to medullary carcinomas?

Answer 10

MEN2

Question 11

What are the genetic mutations that predispose to anaplastic carcinomas?

Answer 11

MEN2
p53
B-catenin

Question 12

Describe papillary carcinomas?

Answer 12

solitary nodule often calcified with plasmalemma bodies

associated with Hashimotos thyroiditis

Question 13

How do papillary carcinomas normally present?

Answer 13

metastesise to lymph nodes (often cervical) and present there

if large: 
dysphagia 
hoarseness
cough
dyspnoea

Question 14

What do papillary carcinomas secrete?

Answer 14

thyroglobulin - as they are TSH driven and take up iodine

Question 15

What is the prognosis of papillary carcinomas?

Answer 15

95% at 10 years

Question 16

Describe follicular carcinomas?

Answer 16

single painless nodule that slowly enlarges

Question 17

How can follicular carcinomas spread?

Answer 17

haematological

Question 18

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

Answer 18

females

older age

Question 19

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

Answer 19

areas of iodine deficiency

Question 20

What is the prognosis of follicular carcinomas?

Answer 20

minimal spread - 90% at 10years

widespread - 50% at 10years

Question 21

Describe medullary carcinomas?

Answer 21

derived from C cells and associated with amyloid deposition

Question 22

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

Answer 22

sporadic = solitary nodule
familial = bilateral/multicentric/C cell hyperplasia

Question 23

What can medullary carcinomas lead to?

Answer 23

paraneoplastic syndromes

• diarrhoea - VIP production
• cushings - ACTH production

Question 24

Describe anaplastic carcinomas?

Answer 24

undifferentiated, rapid growth with involvement of neck structures

Question 25

What is the prognosis of medullary carcinomas?

Answer 25

70-80% at 5 years

Question 26

What population presents with anaplastic carcinomas?

Answer 26

older people

Question 27

How is the treatment for thyroid carcinomas assessed?

Answer 27

ultrasound guided fine needle aspiration | excision biopsy of lymph nodes

Question 28

What is the scoring system to assess thyroid cancers?

Answer 28

``` AMES Age Metasteses Extent of primary tumour Size of primary tumour ```

Question 29

What is the criteria for an AMES low risk?

Answer 29

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

Question 30

What is the criteria for an AMES high risk?

Answer 30

all patients with distant metastasis

Question 31

What is the treatment for AMES low risk?

Answer 31

thyroid lobectomy with isthmuscetomy

Question 32

What is the treatment for AMES high risk?

Answer 32

subtotal thyroidectomy | total thyroidectomy

Question 33

What is the treatment if there is nodal involvement?

Answer 33

lymph node surgery plus thyroidectomy etc

Question 34

What should all patients recieve after thyroid surgery?

Answer 34

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)

Question 35

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

Answer 35

``` T4 = 4 weeks prior T3 = 2 weeks ```

Question 36

Describe thyroid remnant ablation?

Answer 36

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

Question 37

Why is thyroid remnant ablation given?

Answer 37

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