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Flashcards in Endocrine - Online MedEd - Thyroid nodules Deck (13):

Thyroid nodules - what is it the real question?

Is this a cancer?


Ultimate way to determine dx...



Risk factors of thyroid malignancy

1) Patient
2) Physical exam findings
3) US findings


Thyroid cancer - patient risk factors

*Patients who have received radiation to head and neck - Hodgkin lymphoma survivors
Personal history of cancer
Family history of cancer
Hoarseness (nodule doesn't normally invade tissue)
Age <20, >60


Thyroid cancer - physical exam risk factors

Fixed, firm, hard, positive LN nearby, usually contender
Most nodules don't hurt


US risk factors for thyroid cancer

Size > 2cm (need biopsy)
Irregular borders


Find a nodule.. what is the first thing?

Check TSH
If thyroid is hyper functioning.. risk of cancer is low! (hyperthyroidism... low TSH is low risk nodule!)
-If TSH is low and T4 high --> can do RAIU scan to make sure T4 is coming from thyroid --> if lights up --> hyperthyroid and hyper functioning! Not cancer
Now treat hyperthyroidism
-What if RAIU scan is cold? Non-functioning nodule that is at risk of cancer --> will need to do US and FNA
-What if TSH is normal or low? Don't do RAIU, this is a high risk nodule --> Get US --> going to be based on risk and size
-US shows nodule >1cm, super high risk and need FNA
-US shows <1cm, small nodule, can watch and wait and repeat US in 6-12 months --> if growing, go to FNA. But also consider background of patient like other risk factors


Treatment of cancer...

If shows not cancer... follow US 6-12 months, if bigger, re-biopsy
Keep biopsing until you get a definitive answer


Know the 4 cancers of thyroid

1) Papillary
2) Follicular
3) Medullary
4) Anaplastic


Papillary thyroid cancer

Orphan Annie nuclie
85-90% most common
Surgery is treatment


Follicular thyroid cancer

Looks like normal thyroid
Spreads hematogenous
If gave radioactive iodine ablation --> gets ALL of the cancer (plus thyroid)
-This is the best one to have


Medullary thyroid cancer

Associated with C cells and calcitonin
Calcitonin down --> hypocalcemia
-part of MEN IIA/IIb
-associated with RET oncogene and pheochromocytoma


Anaplastic thyroid cancer

Happens in elderly
Locally invasive
Rapidly fatal
Chokes out the trachea, esophagus