Week 3 - Swelling in the neck in a 58 year old man Flashcards
A 58-year old man presents with a 6 month history of swelling in the neck. This has been getting slowly bigger and is not painful. He has no other symptoms and the history is otherwise unremarkable. The swelling moves upwards on swallowing. What is the abnormality seen in the image?
What further information would you like from the history?
What are the key features of a problem-oriented examination of a patient with suspected thyroid disease?
Examination of a goitre
What are the possible causes of this man’s thyroid lump?
What investigations would you organize? (6)
What is the the most specific, sensitive, and cost-effective of all thyroid investigations?
What does the cytology of the fine needle aspirate of the thyroid mass reveal?
What does his ultrasound scan show?
What would you tell the patient at this stage?
(following FNA & ultrasound results)
What do you tell this patient about the surgery?
The patient undergoes aright thyroid lobectomy and makes an uneventful recovery. What does the specimen (Figure 5.4) show?
What do you need to tell a patient who has a confirmed invasive follicular carcinoma?
Describe an approach to a lump in the thyroid.
- Aims of management?
- Process?
Follicular carcinoma of the thyroid:
- Incidence?
- Peak age incidence?
- Population?
Follicular carcinoma of the thyroid:
- Risk factors? (3)
- Presentation? (2)
- Diagnosis? (2)
Follicular carcinoma of the thyroid:
- Treatment? (1)
- Follow up? (2)
What is a Goitre?
- 6 Causes?
Goitre: Goiter is any abnormal enlargement of the thyroid gland.
Aetiology:
1. Iodine deficiency (leading cause of goiter worldwide)
2. Inflammation (e.g., Hashimoto thyroiditis, subacute granulomatous thyroiditis)
3. Graves disease
4. Thyroid cysts (e.g., thyroglossal cyst)
5. Thyroid adenomas
6. Thyroid carcinomas
Classification of a goitre:
- By growth pattern?
- By thyroid function?
- By dignity?
Which investigations would you do for someone with a goitre?
Algorithm for the evaluation of a thyroid mass?
Algorithm for evaluation of goiter in adults without obstructive symptoms?
Causes of Goitre in adults?
What is a Diffuse Nontoxic (Simple) Goitre?
- Clinical Features?
Clinical Features
As stated earlier, most persons with simple goiters are clinically euthyroid. Therefore, the clinical manifestations are primarily related to mass effects from the enlarged thyroid gland. Although serum T3 and T4 levels are normal, the serum TSH is usually elevated or at the upper range of normal, as is expected in marginally euthyroid individuals. In children, dyshormonogenetic goiter, caused by a congenital biosynthetic defect, may induce cretinism.
What is a Multinodular Goitre?
Multinodular Goitre - Pathogenesis?
Multinodular Goitre - Clinical Features?
Thyroid Neoplasms:
- Incidence?
- Sex?
- Neoplastic vs. Benign?
- Criteria that provide clues to the nature of the thyroid nodule?
What is a Thyroid Adenoma?
Describe the pathogenesis of Thyroid adenomas?
Thyroid adenoma:
- Clinical features?
- Pathology/Morphology?
4 types of Thyroid carcinomas?
Thyroid cancer tumor markers:
- Follicular or papillary thyroid cancer?
- Medullary carcinoma?
- Indications?
Pathology of Papillary thyroid cancer? (3)
Pathology of:
- Follicular thyroid cancer?
- Medullary thyroid cancer?
- Anaplastic thyroid carcinoma?
Anaplastic thyroid carcinoma: Undifferentiated giant cell (i.e., osteoclast-like cell)
