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Year 2 Endocrine > Thyroid Tumours > Flashcards

Thyroid Tumours Flashcards

1
Q

The incidence of papillary and follicular tumours are falling?

A

False

Incidence is increasing as the mortality falls

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2
Q

What in papillary and follicular tumours is there a strong association with?

A

Radiation exposure

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3
Q

Are follicular and papillary tumours TSH Independent?

A

False they are TSH dependant

Most take up iodine and secrete thyroglobulin

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4
Q

What ways are follicular and papillary tumours found?

A

Palpable lump
Small chance findings from thyroidectomy
5% present the pathological Metastatic disease

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5
Q

What are follicular tumours strongly linked to?

A

Iodine deficiency

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6
Q

How do papillary tumours prefer to spread?

A

Lymph

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7
Q

How do follicular tumours prefer to spread?

A

Haematogenous

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8
Q

What is the main investigation for thyroid tumours?

A

Ultrasound with fine needle aspiration

+/- excision biopsy of lymph nodes

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9
Q

What isn’t used in the investigation of thyroid tumours?

A

No CT, MRI or thyroid scan

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10
Q

What are some clinical predictors of malignancy?

A

Thyroid nodule is <20 or over >50
Head and neck irradiation
Rapidly growing

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11
Q

What is the mainstay of treatment in thyroid tumours?

A

Thyroidectomy and RAI

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12
Q

What is RAI

A

Radioactive Iodine therapy

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13
Q

What is the scale used for determining severity of disease?

A

AMES

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14
Q

What factors determine the AMES score?

A

Age
Metastasis
Extent of primary tumour
Size of primary tumour

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15
Q

What would be a stereotypical low AMES score?

A

Young with no metastatic disease

Old with a minimally invasive primary

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16
Q

What would be a stereotypical high AMES score?

A

Distant metastasis
Extra-thyroid disease
Capsular invasion (follicular)

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17
Q

What is the surgery usually used in a low AMES risk?

A

Thyroid lobectomy with isthmus

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18
Q

What would indicate a lobectomy?

A

Papillary Microcarcinoma <1cm

Minimally invasive follicular

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19
Q

What is the surgery usually used in a high risk AMES score?

A

Sub or total thyroidectomy

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20
Q

What would indicate a sub or total thyroidectomy?

A

Differentiated thyroid cancer + extra thyroidal spread
- distant mets or nodal involvement
Bilateral or multifocal tumours

21
Q

In papillary cancer what is the nodal clearance?

A

Central compartment clearance

Lateral node sampling

22
Q

In follicular cancer what is the nodal clearance?

A

Central compartment clearance

23
Q

What is done acutely in post operative care?

A

Calcium is checked 24 hours post surgery

24
Q

At what level is the calcium meant to be above?

A

2 mmol/l

25
Q

What level of calcium requires urgent treatment?

A

1.8 mmol/l

IV calcium

26
Q

What is done 3-6 months post operatively ?

A

Whole body iodine scan

27
Q

In what circumstances is a whole body iodine scan completed?

A

High AMES risk

Sub or total thyroidectomy

28
Q

What is key in a whole body iodine scan?

A

Must have high TSH level to drive iodine uptake

29
Q

How are high TSH levels ensured in whole body iodine scan?

A

T3/4 injection are stopped weeks before

rhTSH is injected

30
Q

If the scan as taking place in a week what is the timeline?

A

rhTSh administered on the Monday and Tuesday

Iodine capsule is given on the Wednesday

31
Q

What iodine isotope is used?

A

I-131

32
Q

Why do the tumours take up the iodine?

A

Synthetically induced high TSH levels and the fact the tumours are TSH dependant

33
Q

What does the scan show?

A

Any thyroid remnants

Any tumour which takes up the iodine

34
Q

In Thyroid remnant ablation therapy how many capsules are given?

A

2 or 3

200x more radiation than diagnostic

35
Q

How are patients prepared for ablation therapy?

A

Same as in whole body iodine scan

36
Q

What precautions are taken in ablation therapy?

A

Lead lined room
Sewage connected directly to the mains
Disposable cutlery clothes and bedding
Minimal/ no nurse and family contact

37
Q

What level can patients be discharged?

A

radiation must be below 500 cps at 1 metre

38
Q

How long does the level take to drop to a safe level?

A

usually 48 hours

39
Q

What are the side effects of ablation therapy?

A

Sore throat

40
Q

What is key in the follow up post ablation therapy?

A

Maintained in T4

Suppress TSH to prevent growth

41
Q

What can be used a tumour marker post ablation?

A

Thyroglobulin levels

42
Q

What should TSH levels be kept below?

A

<0.1 mU/l

43
Q

Why should TSH levels be suppressed?

A

TSH drives the growth of the tumour, by reducing levels you can inhibit the growth of the tumour

44
Q

List long term effects of ablation therapy

A

Small increased risk of acute myeloid leukemia

45
Q

Does ablation therapy increase your risk of tumour developmen?

A

No

46
Q

In what time period is recurrence most likely to occur?

A

Within the first two years

47
Q

Which tumour caries the greatest risk of recurrence in the same sight?

A

Pappiliary

48
Q

If a follicular tumour where to recur where would it be most likely to?

A

Lung
Bone
Brain

49
Q

If there is a rising thyroglobulin level but the whole body iodine scan is negative what might have occurred and what is the correct corse of action?

A

Tumour has become anaplastic

PET scan the entire body

Year 2 Endocrine (21 decks)

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