24 Neoplastic - Endocrine

Question 1

What percent of thyroid CA are well diff

Answer 1

> 90%

Question 2

What percent of thyroid nodules are malig

Answer 2

<5%

Question 3

What percent of thyroid nodules are malig in pts w/ h/o RT exposure

Answer 3

30-50%

Question 4

What is the avg lag time b/w radiation exposure and development of thyroid CA

Answer 4

15-25 yrs

Question 5

What is m/c thyroid nodule

Answer 5

Follicular adenoma

Question 6

What is significance of age with thyroid nodules

Answer 6

More likely to be malig in women over 50 and men over 40 and in both men and women under 20

Question 7

What percent of solitary thyroid nodules in kids are malig

Answer 7

50%

Question 8

What is significance of size w/ thyroid nodules

Answer 8

more likely to be malig if >4 cm

Question 9

What is diff in incidence of malig b/w solitary and multiple nodules

Answer 9

5-12%; 3%

Question 10

What percent of malig thyroid nodules are suppressible by exogenous TSH

Answer 10

16%

Question 11

What percent of benign thyroid nodules are suppressible by exogenous TSH

Answer 11

21%

Question 12

What are the 3 types of well-diff thyroid malig

Answer 12

Papillary, Follicular, Hurthle cell

Question 13

What thyroid CA is a/w iodine deficiency

Answer 13

Follicular

Question 14

Which thyroid CA is more likely to be seen in a 30 yo

Answer 14

Papillary

Question 15

Which thyroid CA is more likely to be seen in a preg woman

Answer 15

Follicular

Question 16

Which thyroid CA has best prog

Answer 16

Papillary

Question 17

Which well-diff thyroid CA is relatively unresponsive to ablation with RAI

Answer 17

Hurthle cell

Question 18

65 yo F p/w cervical LN. FNA shows well-diff thyroid tissue. Thyroid has no palpable abnlity. What is next step?

Answer 18

Total thyroid and ND

Question 19

What factor best correlates with the presence of LN mets in papillary CA

Answer 19

Age

Question 20

T/F: Microscopic LN involvement does not change the long-term survival in pts with papillary thyroid CA

Answer 20

True

Question 21

What is the incidence of multicentric dz on path exam of entire thyroid in pts with papillary CA (>1 cm)

Answer 21

70-80%

Question 22

What histo subtypes of thyroid tumors are a/w an inc risk of local recurrence and mets

Answer 22

Tall cell, columnar, insular, solid variant, and poorly diff

Question 23

“A 36-year-old woman presents with a 3 cm papillary carcinoma and no clinical evidence of lymph node involvement, no intrathyroidal vascular invasion, and no gross or microscopic multifocal disease. She has no history of neck radiation and no family history of thyroid cancer. She was treated with a total thyroidectomy. Is radioiodine ablation therapy indicated?

Answer 23

No

Question 24

M/c site of mets from follicular thyroid CA

Answer 24

bone

Question 25

How is the definitive dx of follicular thyroid CA made

Answer 25

capsular invasion at the interface of the tumor and the thyroid gland

Question 26

What is the most imp prognostic factor of follicular thyroid CA

Answer 26

degree of angioinvasion

Question 27

T/F: Follicular cell CA is more aggressive than Hurthle cell

Answer 27

False

Question 28

What is the incidence of pts with Hurthle cell CA who present with distant mets

Answer 28

15%

Question 29

What are the 3 most well known prognostic systems for well diff thyroid CA

Answer 29

GAMES AMES AGES

Question 30

What are the indications for adjuvant thyroid hormone in pts with well-diff thyroid CA

Answer 30

All pts w/ WDTC should be tx with thyroid hormone to suppress TSH for life, regardless of extent of surgery

Question 31

In what 4 settings does MTC arise? Which have best and worst prognosis

Answer 31

sporadic (worst prog) familial (best prog) in a/w MEN IIa or IIb

Question 32

Which type of MTC tends to occur unilaterally

Answer 32

Sporadic

Question 33

Which of the MTC types presents earliest

Answer 33

MEN IIb (mean age 19(

Question 34

What percent of MTC is sporadic

Answer 34

70-80%

Question 35

What are the characteristics of familial MTC

Answer 35

Auto Dom; not a/w any other endocrinopathies

Question 36

What d/o present in MEN IIa

Answer 36

MTC Phenochromocytoma Parathyroid hyperplasia

Question 37

Mean age of presentation in MTC from MEN IIa

Answer 37

27

Question 38

T/F: All pts w/ MEN IIa will have MTC

Answer 38

True

Question 39

What d/o present in MEN IIb

Answer 39

MTC Pheochromocytoma Multiple mucosal neuromas Marfanoid body habitus

Question 40

What percent of MTC secrete CEA

Answer 40

50%

Question 41

Genetic mutation a/w MTC

Answer 41

RET mutation

Question 42

When is ppx thyroidectomy recommended in pts w/ RET

Answer 42

age 5 or 6

Question 43

What is the surgical tx for MTC

Answer 43

Total thyroid, CCND, IPSI ND

Question 44

What percent of pts have had WDTC before developing anaplastic thyroid CA

Answer 44

47%

Question 45

What percent of pts have had benign thyroid dz before developing anaplastic thyroid CA

Answer 45

53%

Question 46

What are the 2 types of anaplastic thyroid CA

Answer 46

``` large cell (more common) and small cell (unresponsive to radiation) ```

Question 47

Tx for anaplastic

Answer 47

debulking and trach for palliation of airway obstruction

Question 48

Tx for primary Non-hodgkin's lymphoma of thyroid

Answer 48

CRT

Question 49

A 44-year-old man presents witha5cm thyroid nodule. FNA returns fluid, the nodule disappears, and the cytology is benign. What is the next step in management?

Answer 49

Total thyroidectomy should be considered bc there is an inc chance of malig in large cysts

Question 50

56 yo M with no RF p/w thyroid nodule. FNA nondiagnostic. Tx of choice?

Answer 50

thyroid lobe

Question 51

Indications for postop RAI

Answer 51

- Known distant mets - Gross extrathyroidal extension of tumor - Tumors > 4 cm - Tumors 1-4 cm when T&N status/age/histo features predict an intermediate to high rate of recurrence

Question 52

T/F: Multifocal WDTC < 1 cm w/o high risk features do not require postop RAI

Answer 52

True

Question 53

Which med improves QOL when preparing pts for radioiodine scanning and ablation rx

Answer 53

Recombinant TSH stimulation (rTSH)

Question 54

How are pts w/ MTC managed postop

Answer 54

Receive L-thyroxine and 2 wks of Ca and Vit D supplementation Serial measures of calcitonin and CEA