Flashcards in EXAM #1: THYROID CANCER Deck (39):
1
What is the difference between a tyroglossal duct cyst and a cervical cyst?
Midline= thyroglossal duct cyst
Lateral= cervical cyst
2
Where does the superior thyroid artery come from?
External carotid artery
3
Where does the inferior thyroid artery come from?
Thyrocervical trunk
4
What is a potential complication of a tracheostomy that results in excessive bleeding?
Transsection of a "Thyroid ima artery" that runs along the anterior trachea
5
Where does the Inferior thyroid vein drain?
Brachiaocephalic
6
Where do the superior and middle thyroid veins drain?
Internal jugular vein
7
What nerve do you need to be especially conscious of when performing a thyroidectomy?
Recurrent laryngeal nerve of the vagus
*Most common is Injury to the external branch of the superior laryngeal nerve--not a big deal. Most dreaded is injury to the recurrent laryngeal bilaterally.
8
What does the recurrent laryngeal nerve innervate?
All intrinsic muscles of the larynx EXCEPT the cricothyroid muscle
9
Where does the recurrent laryngeal nerve lie?
tracheoesophageal groove
10
What is the differential diagnosis for a thyroid nodule?
1) Cyst
2) Thyroid adenoma
3) Infection/ thyroiditis
4) Developmental abnormality
5) Carcinoma
6) Thyroid lymphoma
*Note that most are NOT malignant
11
What is an important historical feature to ask patients about when taking a thyroid related history?
Radiation exposure
12
What is the most reliable and cost effective method for diagnosing thyroid nodules? When is this absolutely indicated?
FNA
*Note that this is indicated for any nodule greater than 1 cm; less than 1 cm is less clear
13
What information can you discern from a thyroid US?
1) Solid vs. cystic
2) Homogenous vs. heterogenous
14
If a radionuclear scan of the thyroid is performed, which is more likely to be malignant--hot or cold nodule?
Cold nodule
15
What are the differentiated thyroid cancers? How are these followed and treated?
1) Papillary
2) Follicular
3) Hurthle Cell
*Followed with thyroglobulin and treated with radioactive iodine
16
What is the c-cell cancer?
Medullary Thyroid Cacner
17
What is pathognomonic for papillary thyroid cancer?
Psammoma bodies
18
What is Follicular Thyroid Cancer?
Neoplastic proliferation of thyroid follicles that invades the capsule
19
How is follicular thyroid cancer spread?
Hematogenously
20
Where does follicular thyroid cancer commonly metastasize?
- Bone
- Lung
- Liver
- CNS
21
What is Hurtle Cell Cancer?
Variant of Follicular Thyroid Cancer
*Difficult to determine if benign or malignant via FNA
22
What is Medullary Thyroid Cancer?
Malignant neuroendocrine tumor of parafollocular C-cells
23
What are the markers for Medullary Thyroid Cancer?
Calcitonin
CEA
24
What do you need to screen for in patients with Medullary Thyroid Cancer?
1) Pheochromocytoma
2) Hyperparathyroidism
25
What syndromes are associated with Medullary Thyroid Cancer?
MEN 2A and 2B
26
Is medullary thyroid cancer response to radioactive iodine?
NO
27
What do you need to measure after surgery for medullary thyroid cancer?
Calcitonin
28
What are the clinical features of anaplastic thyroid cancer?
- Rapidly enlarging
- Painful
- Symptomatic
29
What is the primary treatment for anaplastic thyroid cancer?
Chemoradiation
30
What is Thyroid Lymphoma?
Rare lymphoma that develops from the thyroid gland
31
What is the treatment for thyroid lymphoma?
Chemoradiation
32
If a thyroid tumor is less than 1 cm in size, what surgical procedure should be performed?
Lobectomy
33
What stage are all anaplastic carcinomas considered?
Stage IV--worst prognosis
34
What are the best relative 5-year survival rates for the thyroid cancers?
1) Papillary
2) Follicular
3) Medullary
35
When is lymph node dissection warranted?
Grossly positive nodes on physical exam or imaging--no consensus otherwise
36
What are the post-surgical complications of a thyroidectomy?
1) Hematoma
2) Nerve injury
3) Hypocalcemia
37
What is Chovstek's sign?
Tapping on the cheek causes spasm
38
What is Troussseau's sign?
Carpopedal spasm with BP cuff
39