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Flashcards in 4: Management of thyroid nodules Deck (36)
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1

What are the two main types of thyroid nodule?

Solitary thyroid nodule

Multinodular goitre

2

The vast majority of solitary thyroid nodules are ___.

benign

3

Who tends to develop thyroid nodules?

Women

4

What is the most common type of malignant thyroid nodule?

Papillary thyroid carcinoma

5

Papillary and ___ thyroid carcinomas are malignant epithelial tumours.

papillary and follicular

6

What is a malignant cancer of the parafollicular cells of the thyroid?

Medullary thyroid carcinoma

7

Which fascial layer contains the thyroid?

Pretracheal fascia

8

What happens to the thyroid when you swallow?

Moves up and down along with the larynx

Nodules should move up and down as well

9

Thyroid nodules are usually (painful / painless).

painless

10

When would a thyroid nodule be painful?

Usually bleeding into a cyst > expansion > nerve compression

11

What two questions must be asked on history of a thyroid lump?

Neck irradiation?

Family history of thyroid cancer?

helps differentiate between benign and malignant

12

What two signs must be checked for on examination of a thyroid lump?

Enlarged lymph nodes

papillary spreads via lymph, follicular haematogenously

Hoarseness

recurrent laryngeal nerve palsy - can be eroded by cancer

13

What are two important investigations for someone presenting with a neck lump?

TSH

usually normal, suppressed in hypothyroidism, solitary toxic adenoma

Ultrasound - Fine Needle Aspiration

14

How are thyroid nodules investigated?

Thyroid function test for TSH

Ultrasound-guided fine needle aspiration for biopsy

15

What classification systems are used to describe thyroid nodules viewed by

a) FNA

b) Ultrasound?

a) FNA - Thy 1 to 5

b) Ultrasound - U1 to U5

16

What else can ultrasound scanning pick up?

Lymphadenopathy

17

What are the two surgical options for solitary thyroid nodules?

Lobectomy

Total thyroidectomy

18

When is lobectomy advised?

Low risk group:

Aged < 50, tumour < 4cm

19

When is total thyroidectomy advised?

High risk patients:

Age > 50, tumour > 4cm, TSH low

20

What common staging system can be used to stage thyroid cancer?

TNM staging

21

Following treatment of a thyroid cancer, what is the ideal TSH level?

Lower range of normal

You don't want thyroid to be too metabolically active

22

What is used as a marker for differentiated thyroid cancer activity after treatment?

Thyroglobulin

23

Diagnosis of follicular thyroid carcinoma depends on what?

Invasion of thyroid capsule

24

How does follicular thyroid carcinoma spread?

By blood

25

Most follicular thyroid carcinomas are (invasive / minimally invasive).

minimally invasive

26

What percentage of women are on thyroxine for autoimmune hypothyroidism?

5%

27

What type of thyroid nodule can occur in women as a conseqeuence of long term thyroxine use?

Thyroid lymphoma

28

Thyroid lymphomas have an (insidious / rapid) onset.

rapid onset

29

How are thyroid lymphomas treated?

Steroids

Then chemo/radiotherapy

30

Medullary thyroid carcinoma is a malignant cancer of the C cells which produce ___.

calcitonin