Tiemann Thyroid Nodules

Question 1

Thyroid nodule, what should we ask about?

Answer 1

radiation history

family history– esp. MEN

Question 2

Thyroid nodule. First steps?

Answer 2

Thyroid function studies:
TSH, T3/T4

If TSH is up or down, need radioactive iodine scan

If TSH is down, hyperthyroid- take out the hot nodule

If euthyroid, do ultrasound and then FNA

Question 3

biopsy shows benign. What next?

Answer 3

retest; some false negatives

Question 4

what’s useful in following up medullary carcinoma?

Answer 4

YES: serum calcitonin levels, thyroid replacement (if total thyroidectomy)- so then, TSH levels- we want it to be on the higher edge of normal.
MEN 2a and 2b surveillance

NOT: thyroglobulin, radioactive iodine

Question 5

screen for what before medullary carcinoa surgery?

Answer 5

pheochromocytoma

Question 6

what do we do with family members who have positive ret proto oncogene?

Answer 6

total thyroidectomy

Question 7

pappillary carcinoma- surgery of choice?

Answer 7

total thyroidectomy

• it’s a multifocal cancer
• also need to get rid of the radioactive iodine that was taken up diffusely

Question 8

follicular carcinoma surgery of choice?

Answer 8

lobectomy- unifocal

do surgery if the gene expression classifier is suspicious

if during surgery it is looking malignant, then do total thyroidectomy