w3 - thyroid cancer

Question 1

what type of cell does cancer grow from in thyroid cancer - papillarly, follicular, medullarly, anaplastic?

Answer 1

papillary - 76%

Question 2

differentiated refers to histological appearance + physiological characteristics, most cancers will take up ___ and secrete ___. differentiated - good or bad prognosis?

Answer 2

iodine

thyroglobulin

Question 3

thyroid cancer is uncommon in children t.f

Answer 3

true

Question 4

thyroid cancer is more common in females

Answer 4

true - 2/3x

Question 5

t.f there is no association with diet, malignancies, family history, smoking but there is of radiation

Answer 5

true

Question 6

how does thyroid cancer present

Answer 6

palpable nodules

Question 7

papillary thyroid cancer tends to spread via ___, but also haematogenous spread to __, ___, __ and brain. It is associated with __ __

Answer 7

lymphatics
lungs, bone, liver
hashimotos thyroiditis

Question 8

initial investigation of suspected thryoid cancer

Answer 8

ulstrasound guided FNA (fine needle aspiration) of lesion

Question 9

if vocal cord palsy suspected, what is done pre-op

Answer 9

laryngoscopyn

Question 10

clinical predictors of malignancy 6

Answer 10

new thyroid nodule age <20 or >50 
male
nodule increasing in size
lesion>4cm 
history of head and neck irradiation 
vocal cord palsy

Question 11

the types of surgery for thyroid cancer are - thyroid lobectomy with isthmusectomy, sub-total and total thyroidectomy. risk stratification post-op uses AMES - what does this stand for

Answer 11

Age (men<40, women <50)
Metastases
Extent of primary tumour
Size of primary tumour (<5cm)

Question 12

when is thyroid lobectomy with isthmusectoy carried out

Answer 12

papillary microcarcinoma <1cm
minimmaly invasivw
low risk - AMES

Question 13

t.f patients with microscopic lymph node disease should undergo nodal clearance

Answer 13

false

macroscopic lymph node disease = nodal clearance

Question 14

for lymph node surgery, outline post-op care

Answer 14

calcium checked within 24hrs
caclcium replacement if calcium falls below 2mmol/l
IV calcium if <1.8mmol/1 or symptomatic
Patient discharged on T3 or T4

Question 15

if the patient has undergone sub/total thyroidectomy - what is performed postop

Answer 15

whole body iodine scanning
-3-6months after
T4 stopped 4 weeks prior
T3 stopped 2 weeks prior

Question 16

outline the week of whole body iodine scan

Answer 16

(sensitivity determined by TSH elevation)
rhTSH injected - Mon/TUes
I-131 administered as capsule on Wednesday
Imaging - friday

Question 17

after the whole body scan, what is the next step if still persistent

Answer 17

thyroid remnant ablation

(treated with rhTSH prior, given I-131 and discharged when count rate <500cps at 1m

Question 18

side effects of thyroid remnat ablation

Answer 18

sialadenitis - salivary gland infection

sore throat

Question 19

t/f after TRA patient maintained on T3

Answer 19

false

T4

Question 20

aims for follow-up after TRA

Answer 20

suppress TSH to <0.1mU/1 and FT4 <25

thyroglobulins used as a tumour marker

Question 21

recurrence in cervical lymph nodes is commoner in ___ thyroid cancer, whereas haematogenous spread is more common in ___ lesions

Answer 21

papillary

follicular

Question 22

2 drugs approved for Diff TC

Answer 22

sorafenib

lenvatinib