Thyroid/Para

Question 1

Bethesda 1

Answer 1

Nondiagnostic (ROM up to 20%)
Rpt FNA accurate 60-80%

Question 2

Bethesda 2

Answer 2

Benign (2-7%)
Follow up in 6 months with US

Question 3

Bethesda 3

Answer 3

AUS (15-35%)
Higher if cellular atypica

Question 4

Bethesda 4

Answer 4

Follicular neoplasm
Follicular with oncocytic features higher ROM
20-40%

Question 5

Bethesda 5

Answer 5

Suspicious for malignancy
65-85%
Usually papillary

Question 6

Papillary > 1 cm indications for total thyroid

Answer 6

Bilobar disease
>4 cm
Older age
Male
Positive LN
Radiation
Extrathyroidal extension
Distant mets

Question 7

Post lobectomy indications for completion?

Answer 7

> 4 cm
ETE
N1a disease (not required for 5 nodes with less than 2 mm deposits)
Vascular invasion
Positive margins
Contralateral disease

Question 8

Total thyroidectomy followup

Answer 8

6-12 months US, then annual US
Tg, TSH at 6-12 weeks
Measure Tg, Tg antibody and TSH annually

Question 9

Follicular indications for completion thyroidectomy?

Answer 9

• Widely invasive
• Encapsulated angioinvasive (>4 vessels)
  Minimally invasive, < 4 vessels NIFTP and follicular adenoma DO NOT need completion

Question 10

Oncocytic carcinoma

Answer 10

Indications for total same as follicular

Question 11

Medullary thyroid carcinoma management

Answer 11

• > 1 cm total thyroid with level 6
• Ipsilateral or bilateral lateral neck for clinically or radiologically positive nodes
• Prophylactic lateral neck for high volume disease in thyroid or central neck
• < 1 cm still needs total thyroid with central neck

Question 12

Medullary MEN2 B treatment?

Answer 12

Thyroidectomy by age 1
Para as well if hypercalcemic

Question 12

Medullary MEN2A treatment?

Answer 12

Thyroidectomy with neck diss as needed by age 5

Question 13

Targeted therapy medullary thyroid cancer?

Answer 13

TKI (Vandetanib)
Selpercatinib for RET

Question 14

TSH levels after total

Answer 14

High risk < 0.1
Low risk 0.1-0.5

Question 15

Prep for RAI

Answer 15

Allow TSH >30 (3-6 weeks after surgery)
0r 2 doses of rTSH
Iodine free diet 2 weeks

Question 16

TIRADS?

Answer 16

1benign- score 0-1
2 not suspicious- score 2 ( no FNA)
3- score 3 mildly suspicious (biopsy >2.5, observe >1.5)
4- score 4-6(biopsy >1.5, observe >1)
5- >7 ( biopsy >1)

Question 17

TIRADS markers?

Answer 17

Composition (0-2)
Echogenecity (0-3)
Size (0 or 3)
Margins (0-3)
Echogenic foci(0-3)

Question 18

Medullary cancer calcitonin level for distant met imaging?

Answer 18

> 500

Question 19

WHO 2022 classification of thyroid cancers?

Answer 19

Follicular carcinoma
Encapsulated invasive follicular variant of papillary
Papillary
Oncocytic
Medullary
Follicular derived carcinomas, high grade
Anaplastic

Question 20

Genetic mutations in thyroid cancers?

Answer 20

Papillary (MAPK pathway, BRAF 60%)
Follicular (RAS 66%, nras most common)
Hurthle (BRAF and RAS rare, high mitochondrial DNA mutations)
Medullary (>95% RET)
Anaplastic (TP53 and TERT more common)

Question 21

PET avid thyroid nodule malignancy rate?

Answer 21

30-40%

Question 22

Thyroid molecular tests ?

Answer 22

Affirma (binary, benign or suspicious)
Thyroseq ( mutation specific results)

Question 23

Rate of completion thyroidectomy after initial lobectomy for DTC?

Answer 23

10-20% in 10 years

Question 24

ATA high risk features?

Answer 24

Extrathyroidal extension
LN > 3cm
Incomplete resection
Distant mets

Question 25

ATA intermediate risk features?

Answer 25

Vascular invasion
>5 involved nodes
Aggressive histology
Minor ETE

Question 26

ATA low risk

Answer 26

Intrathyroidal DTC
<5 LN wiht micromets

Question 27

Thyroglobulin levels concerning for recurrence?

Answer 27

Stimulated Tg > 10
1-10 can be treated with TSH suppression

Question 28

Parathyroidectomy indications in asymptomatic patients?

Answer 28

> 1mg above normal
Age <50
GFR < 60
Osteoporosis
Nephrocalcinosis

Question 29

Medullary carcinoma targeted therapy?

Answer 29

RET inhibitors (Selpercatinib)