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Thyroid Cancer Flashcards

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1
Q

What is the cause of a thyroglossal duct cyst?

A

Ectopic thyroid tissue and/or cysts present along the course of the thyroglossal duct

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2
Q

What is the difference between a thyroglossal duct cyst, and a cervical cyst?

A

Thyroglossal is midline

Cervical is lateral to the SCM

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3
Q

What muscle lie in front of the thyroid? (4)

A

Strap muscles:

  • Thyrohyoid
  • Sternothyroid
  • Sternohyoid
  • Omohyoid
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4
Q

What is the blood supply to the thyroid? (2)

A

Superior thyroid –external carotid artery

Inferior thyroid artery – thyrocervical trunk

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5
Q

What is the thyroid IMA, and when is it important?

A

Artery from the thyrocervical trunk that runs anteriorly along the trachea to the thyroid.

Need to know if tracheostomy

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6
Q

What is the blood supply to the superior pole of the thyroid? What is this a branch of?

A

Superior thyroid artery

External carotid artery

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7
Q

What is the middle thyroid artery a branch of?

A

There is no middle thyroid artery

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8
Q

What are the veins that drain the thyroid?

A

Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein

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9
Q

What is the nerve that runs alongside the thyroid within the carotid sheath?

A

CN X

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10
Q

The inferior thyroid vein drains where?

A

Into the brachiocephalic cein

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11
Q

The superior thyroid vein drains what part of the thyroid? Where does it drain to?

A

Drains the superior pole

Drains into the IJV

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12
Q

What middle thyroid vein drains what part of the thyroid? Where does it drain to?

A

Drains the lateral aspect of the gland

Drains into the IJV

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13
Q

Where does the recurrent laryngeal nerve lie in relation to the thyroid?

A

Deep to it– in the tracheoesophageal groove

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14
Q

What is the course of the vagus nerve on the right side? Left side?

A

Right = wraps around the thyrocervical trunk

Left = wraps around the arch of the aorta

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15
Q

What does the recurrent laryngeal nerve innervate?

A

All intrinsic muscles to the larynx except the cricothyroid muscle

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16
Q

What is the groove that the recurrent laryngeal nerves runs in?

A

Tracheoesophageal groove

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17
Q

What artery does the recurrent laryngeal nerve run near?

A

Inferior thyroid artery

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18
Q

True or false: there is a high incidence of asymptomatic thyroid nodules

A

True

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19
Q

What are the two major types of thyroid nodules?

A

Solitary nodules

Multinodular goiter

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20
Q

What is the risk of malignancy for solitary thyroid nodules?

A

5%

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21
Q

What is the risk of malignancy for a multinodular goiter?

A

1%

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22
Q

What are the characteristics of multinodular goiters (all similar, or all different)?

A

Multiple palpable nodules of similar size and consistency

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23
Q

What should always be asked about in the history when evaluating a thyroid nodule?

A

h/o radiation to the head/neck

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24
Q

What percent of thyroid nodules are malignant?

A

10%

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25
What is the most effective method of diagnosing thyroid nodules? What is the false negative rate of this?
FNAB False negative = 1% ish
26
What is most suspicious for malignancy: a homogenous or a heterogeneous thyroid nodule
Heterogeneous
27
True or false: a FNA can be done in the office setting or with radiology
True
28
Which is more likely malignant: hot or cold nodules?
Cold
29
What percent of all cancers in the US are thyroid cancers? What percent of all endocrine cancers are thyroid cancers?
1.5% of all CAs | 95 of endocrine CAs
30
What are the four types of thyroid cancers in descending order of incidence/badness?
Papillary Follicular Medullary Anaplastic
31
What are the three differentiated types of thyroid cancer?
- Papillary - Follicular - Hurthle cell
32
Which thyroid cancer is made up of undifferentiated cells?
Anaplastic
33
What cancer of the thyroid may/may not be primary?
Lymphoma
34
True or false: surgery is the best option for anaplastic thyroid carcinoma
False-- way too metastatic
35
What is the most common type of thyroid cancer?
Papillary carcinoma
36
What is the prognosis for papillary CA?
Good
37
What is the treatment for papillary thyroid cancer?
Thyroidectomy or lobectomy
38
What is the histological characteristic of papillary cancer?
Psammoma bodies
39
What thyroid cancer has psammoma bodies?
Papillary cancer
40
Who usually gets follicular cancer?
60-70 year olds
41
What type of masses are follicular thyroid cancers?
Solitary
42
What determines if a follicular cancer is benign or not?
If it has penetrated the capsule
43
How does follicular cancer spread? Where does it usually met to (4)?
``` Hematogenously Bone Lung Liver CNS ```
44
What is the treatment for follicular cancer?
Lobectomy plus isthmusectomy if local If invaded capsule, then total thyroidectomy
45
When is a total thyroidectomy indicated for follicular cancer?
If cancer spreads outside the capsule
46
What is Hurthle cell cancer? How do you diagnose this?
Variant of follicular thyroid cancer Need full biopsy
47
What is medullary thyroid cancer?
A neuroendocrine tumor of the parafollicular (C cells) of the thyroid gland
48
What type of cancer arises from the C cells of the thyroid?
Medullary thyroid cancer
49
What is the genetic disease that causes medullary thyroid cancer?
MEN2
50
What percent of medullary thyroid cancers are sporadic?
80%
51
What are the two markers of medullary thyroid cancer?
Elevated calcitonin and CEA
52
What two diseases must be screened for with medullary thyroid cancer?
Pheochromocytoma and hyperparathyroidism
53
What are the three cancers that are associated with MEN1?
- Pituitary adenoma - Parathyroid hyperplasia - Pancreatic tumors
54
What are the three cancers associated with MEN2A?
- Parathyroid hyperplasia - Medullary thyroid CA - Pheochromocytoma
55
What are the three cancers that are associated with MEN2B?
- Mucosal neuromas - Medullary thyroid carcinoma - Pheochromocytoma
56
Which type of MEN has marfanoid body habitus?
MEN2B
57
What is the treatment for medullary thyroid cancer?
Surgery
58
What is the role of radioiodine therapy with medullary thyroid cancer?
Not responsive
59
What is the role of thyroid suppression with medullary thyroid cancer?
None since C cells are not responsive to TSH
60
What is the marker that is followed after surgery for medullary thyroid cancer?
Calcitonin
61
What is the most aggressive of the thyroid cancers?
Anaplastic cancer
62
Who usually gets anaplastic cancer?
80-90 yo
63
What are the ssx of anaplastic cancer?
rapidly enlarging, painful, symptomatic thyroid mass, impinging on the esophagus and the trachea
64
What is the treatment for anaplastic thyroid cancer?
Chemo/rad
65
What is the mean survival time of anaplastic thyroid cancer?
3-6 months
66
How do you diagnose lymphoma to the thyroid?
FNAB
67
What is the treatment for lymphoma of the thyroid?
Radiation and chemo
68
What is the 5 year survival rate of lymphoma?
50-70%
69
Which two of the thyroid cancers are amenable to surgical treatment?
Papillary and follicular
70
What is the size of the tumor that indicates that a lobectomy is preferential to a total thyroidectomy?
Less than 1 cm
71
How do you follow patients who have had a total thyroidectomy?
Monitor thyroglobulin levels
72
What do you do if you accidentally take out the parathyroid glands?
Chop it up and put it into the SCM
73
What is the role of radioablation after a total thyroidectomy?
Get any remaining cells
74
True or false: any lymph nodes that are positive for cancer should be removed
True
75
When, besides having positive lymph nodes, should nodes be removed?
Poor prognostic features
76
Why are hematomas particularly concerning with thyroidectomies?
Large hematomas can cause respiratory distress
77
What is the most common nerve injured in a total thyroidectomy? What nerve produces the least desirable effects?
External branch of the superior laryngeal nerve is most hit Recurrent laryngeal nerve is most deadly
78
What are the ssx of nicking the recurrent laryngeal nerve?
Hoarseness or total airway compromise if both
79
What are the complications that can arise from damaging the external branch of the superior laryngeal nerve?
Pitches may not be able to be reached
80
What is Chvostek's sign?
tapping in CN VII causes spasm with hypocalcemia
81
What is Trousseaus's sign?
BP cuff inflation causes arm spasm with hypocalcemia
82
When is thyroid supplementation started after a total thyroidectomy?
After f/u with endocrinology

Endocrine (32 decks)

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