Endocrine (NMS) Flashcards
What type of thyroid cancer is most commonly seen in someone with a history of neck radiation?
Papillary
What is first step in thyroid nodule evaluation?
FNA
Psammoma bodies
Associated with papillary carcinoma
What is the most type of thyroid cancer?
Papillary carcinoma. Better prognosis
Amyloid deposits are associated with what type of thyroid cancer?
Medullary thyroid cancer; highly malignant. Hyperplasia of parafollicular C cells -> high calcitonin.
Serious complications of thyroid surgery
Injury to recurrent laryngeal nerve. Devascularization of all 4 parathyroid glands -> hypocalcemia
Treatment of papillary cancer
If had prior radiation -> total thyroidectomy. If no previous radiation to neck, can do total thyroidectomy or lobectomy/isthmusectomy. Advantage of total is that thyroglobulin can be used as tumor marker thereafter
Treatment of follicular cancer
Lobectomy/isthmusectomy for well-circumbscribed lesion. If > 4cm microinvasive OR > 1 cm invasive -> total thyroidectomy
Papillary cancer mets via
Lymph nodes
Follicular cancer mets via
Hematogenous
Adjuvant post-op tx for papillary and follicular cancer
TSH suppression with thyroid hormone; possibly iodine ablation. NB: this is not used for medullary b/c that is a problem with parafollicular cells
Clear indications for surgery in asymptomatic hyperPTH due to parathyroid adenoma
Serum Ca > 11.5 mg/dl, age
Surgical treatment of secondary or tertiary hyperPTH
Usually medical management alone unless *bone pain, fractures, intractable pruritus, or soft tissue calcium deposits*. Then you take out all but 50 mg of parathyroid and implant that in the forearm
MEN1
parathyroid hyperplasia, pancreatic tumors, pituitary tumors
MEN2A
parathyroid hyperplasia, pheochromocytoma, medullary thyroid carcinoma
Workup of adrenal mass
