Nodular Thyroid Disease Flashcards
definition of a thyroid nodule?
discrete lesion within thyroid gland
palpable clinically or
distinguishable radiologically from surrounding thyroid parenchyma
Non-palpable nodes – “incidentalomas”
> 1cm need further evaluation
functional nodules?`
“Hot”
↑ I123 uptake - ↑ thyroid hormone synthesis
non functional nodules?
“Cold”
No I123 uptake
non-functional
Differen types of benign and malignant thyroid nodules?
what reduces your risk of thyroid carcinoma?`
multiple nodules
functioning nodules
oral contraceptive pill
Describe multinodular goitre?
Slow-growing over decades
Presentation
thyroid dysfunction
mass effect
Test thyroid function
Hyperthyroidism
risk of atrial fibrillation & osteoporosis
anti-thyroid drugs or I131
5% malignancy risk as with solitary nodules
how to assess multinodular goitre? & symptoms?
history / examination
thoracic inlet x-ray / CT
flow-volume loop
Exertional dyspnoea
Wheeze / stridor
Cough
Dysphagia
Hoarse voice
conditions associated with multinodular goitre?
Goitre
horners syndrome
SVC obstruction
Pemberton’s sign
how does solitary thyroid nodule present and examine?
Presentation
anterior neck lump
symptoms of thyrotoxicosis
mass effects unusual
Enquire about hx of head & neck irradiation / FHx / rapid growth in size of mass
Examination
fixed or mobile, cystic vs. solid
signs of obstruction
palpable cervical lymph nodes
Test thyroid hormones ± calcitonin
Thyroid ultrasound
confirms presence of nodule
cystic vs. solid
Determine malignant potential
fine-needle aspiration biopsy
thyroid scintigraphy (I123, Tc99)
cells of the thyroid?
classiication of thyroid cancer?
treatment for differentiated thyrpid cancer?
Treatment - Surgery
Total thyroidectomy
tumour > 1cm
extrathyroidal extension / metastases
Unilateral lobectomy or isthmusectomy
tumour < 1cm
Regional neck dissection
nodal involvement
Treatment - Radioiodine
Cytotoxicity by β - radiation
Adjuvant ablation
destroy all residual normal thyroid tissue
microscopic residual disease
50% reduction in local & regional recurrence
allows more accurate follow-up
Imaging for recurrent disease
Treatment of recurrent disease
Treatment – Thyroxine replacement
Supraphysiological replacement
Prevent hypothyroidism
Suppress TSH
minimise TSH stimulation of tumour growth
Risks of over-replacement
accelerated bone loss
atrial fibrillation
cardiac dysfunction
Signs of anaplastic thyroid cancer?
Presentation
Rapidly enlarging neck mass (painful)
Constitutional symptoms
anorexia, weight loss, fatigue, fever
Hoarse voice
Presentation
Signs
Asymmetrical thyroid enlargement
Nodular
Painful
Overlying skin changes / ulceration
50% cervical lymphadenopathy
Tracheal deviation
Stridor
Investigations
Assess thyroid function
FNA biopsy
Imaging
USS neck
CT thorax / isotope bone scan
Management
Surgery
Radiotherapy & chemotherapy
Secure airway (tracheostomy)
Nutritional support
medullary carcinoma of the thyroid?
Neuroendocrine tumour of parafollicular / C-cells
Secrete calcitonin
3-5% thyroid tumours
Can be part of MEN II
Presentation
Solitary thyroid nodule
Diarrhoea / facial flushing
Management
Surgery
Thyroxine replacement
Genetic screening (MEN II)
Recurrent / residual disease
chemotherapy
somatostatin analogues
Prognosis
Risk factors
Hashimoto’s thyroiditis
Usually Non-Hodgkins type
Presentation
Presentation
Rapidly enlarging goitre
Lymphadenopathy
Fever / night sweats / pyrexia
Treatment
Surgery
Radiotherapy & chemotherapy
