Assessment of a thyroid mass

Question 1

History

Answer 1

1. Symptoms of hyperthyroid
2. Symptoms of hypothyroid
3. Dysphonia, dysphagia, dyspnea
4. Details of growth of mass
5. Prior head/neck irradiation
6. Recent infections etc
7. Family history medullary thyroid cancer, other thyroid cancer, MEN, Cowdens
8. PMHx, social, occupational, medications, allergies…

Question 2

Examination

Answer 2

1. Complete thyroid examination
2. Hyper/hypothyroid
3. Listen for dysphonia, dyspnea
4. Evidence of other malignancy

Question 3

Investigations

Answer 3

1. TSH
2. T4
3. RAIU if hyperthyroid (TSH suppressed)
4. Autoantibodies
5. Serum calcium, PTH, calcitonin (FHx medullary ca)
6. USS
7. FNA >1cm

Question 4

USS features which may suggest Ca

Answer 4

1. Microcalcifications
2. Absence of vascular halo
3. Irregular margins
4. Taller than wide shape
5. Hypoechoic
6. Increased vascularity

Question 5

Bathesda criteria and management

Answer 5

1. Non diagnostic->repeat FNA
2. Benign->clinical F/U
3. Atypia of undetermined significance or follicular lesion of undetermined significance->repeat FNA
4. Follicular neoplasm or suspicious for follicular neoplasm->Surgical lobectomy
5. Suspicious for malignancy->near total thyroidectomy or surgical lobectomy
6. Malignancy-> near-total thyroidectomy

Question 6

Surgical management algorithm

Answer 6

Includes