Thyroid Flashcards
(19 cards)
What do you do with FLUS/AUS biopsy?
Repeat FNAB in 2-3 months
FLUS/AUS expected stats and actual stats (% of total and % malignant)?
Bethesda 2007 recommended <7% of FNAB and risk of malignancy would be 5-15%.
Reality Risk of malignancy could be asa high as 20-25%
FLUS/AUS repeat biopsy, how often benign?
40-50% of cases repeat biopsy on initial FLUS/AUS biopsy are benign.
What mutations have nearly 100% specificity for papillary thyroid cancer?
BRAF and RET/PTC - should do bilateral thyroid surgery.
Specificity for thyroid cancer if RAS+?
only 60-70%, so if negative for RAS could still be cancer! Lobectomy would still be indicated.
What is risk of malignancy for AUS/FLUS if gene expression classifier studies report benign?
High negative predictive value– 95%– so 5% chance of malignancy.
Describe classic papillary CA, follicular and follicular variant papillary on US and biopsy.
Papillary: US hypoechoic, Path nuclear atypia
Follicular variant papillary: US hyperechoic / isoechoic, Path without nuclear atypia, microfollicular arrangement of cells
Follicular CA: US hyper/isoechoic
What is this likely to be: cellular, sparse colloid except for a few dense clumps surrounded by follicular cells, multiple tiny ringlets of thyroid cells forming microfollicles.
20-25% malignancy, follicular CA or follicular variant papillary (both iso/hyper echoic on US, whereas papillary is hypoechoic)
When should thyroid nodules < 1 cm be evaluated?
History of radiation, family history 1st deg relative with thyroid cancer, associated LAD, suspicious US
How many people have incidental nodules on PET? How are these different than incidental nodules on CT?
1-2%, higher risk of malignancy 33%. BUT diffuse FDG uptake can be thyroiditis.
Name genetic thyroid cancer syndromes
1) Cowden’s syndrome (hamaratomas of skin and mucous membranes), FAP, Carney complex, MEN2, Werner Syndrome (adult progyria)
What nodules can you avoid biopsy until >2 cm?
1) Spongiform 2) Mixed cystic / solid (purely cystic try and avoid FNA)
What nodules do you biopsy < 1 cm?
1) Hx of rads 2) Suspicious features US 3) LAD
What percent of thyroid cancers are >50% cystic on US?
2 cm.
Describe a flow volume loop of severe compressive goiter.
Flattened inspiratory and expiratory loops, fixed upper airway obstruction.
How do you treat a large, compressive goiter?
1) Surgery 2) if not surgical candidate, could consider RAI to shrink part of goiter (but much less preferred)
Normal thyroid size (gm), length, thickness and isthmus.
The normal thyroid weighs approximately 15 to 25 g, with each lobe 4 to 6 cm in length and 1.3 to 1.8 cm in thickness. The isthmus measures less than 4 to 5 mm
DDx of painful thyroid gland.
1) infection (fungal, aspergillus) 2) subacute thyroiditis 3) bleed 4) rarely hashimotos
Subacute thyroiditis - eponym and describe
DeQuervain- after viral infection, unlikely if immunocompromised (think infection)
