OnlineMedEd: Endocrine - "Thyroid Nodules"

Question 1

What patient characteristic correlates with the highest risk of thyroid cancer?

Answer 1

Neck radiation

Look for the person who survived lymphoma and got radiation treatments.

Question 2

List some other patient characteristics that correlate with increased risk of thyroid cancer.

Answer 2

• Advanced age or young age
• Personal or family history of cancer
• Hoarseness

Question 3

LIst the nodule characteristics that increase risk of cancer.

Answer 3

• Firm
• Fixed
• Hard
• Non-tender

Question 4

List the ultrasound characteristics that go with increased risk of cancer.

Answer 4

• Hypoechogenic
• > 2 cm
• Microcalcifications
• Irregular borders

Question 5

The first step in evaluating a thyroid nodule is ______.

Answer 5

TSH

• Low TSH goes with low-risk of malignancy because the nodule is functioning.
• High or normal TSH goes with a high-risk because the nodule is definitely not functional.

Question 6

After the TSH is discovered to be low, get a ______________.

Answer 6

radioactive iodine uptake scan (RAIU scan) to see if it is the nodule that is secreting the T3/T4

• Hyperfunctioning = not cancer, treat hyperthyroidism
• Hypofunctioning = maybe cancer, get an US and FNA.

Question 7

After the TSH is discovered to be high or normal, get a _______________.

Answer 7

US

• > 1 cm: biopsy
• < 1 cm: repeat US in 6-12 months

Question 8

Describe what you should do on FNA results.

Answer 8

• Cancer: resect
• Not cancer: repeat US in 6-12 months
• Indeterminate: repeat FNA until definitive

Question 9

List the four types of thyroid cancer and some facts about each.

Answer 9

•Papillary:

• 85% of thyroid cancers
• orphan Annie nuclei
• resection
• great prognosis

•Follicular:

• 5%
• biopsy looks just like thyroid
• hematogenous spread
• because it is just thyroid, radioactive iodine can kill even metastatic disease

•Medullary:

• c-cells (that make calcitonin)
• RET oncogene
• MEN2B and MEN2A

• Anaplastic:

• elderly people
• locally invasive
• frequently fatal