Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Endocrine > Thyroid Neoplasms > Flashcards

Thyroid Neoplasms Flashcards

1
Q

Name benign nodules of the thyroid

A
  • cyst
  • colloid nodule
  • follicular nodule
  • hyperplastic nodule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of nodules will be malignant?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who are follicular adenomas most common in?

A

Women >30 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the histology of follicular adenomas

A

Discrete solitary mass. Composed of thyroid follicles & encapsulated by collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Are adenomas generally functional or non-functional?

A

Non-functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When are adenomas most likely to be functional?

A

If there is a mutation involved in TSH signalling, increasing cAMP and therefore thyroid hormone production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percentage of all cancers are thyroid cancers?

A

1.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which gender is mainly affected by thyroid carcinoma?

A

Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

State the two cancers which are part of DTC

A
  • papillary

- follicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What hormone drives differentiated thyroid cancer?

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do most DTC take up and secrete?

A

Take up - iodine

Secrete - thyroglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the aetiology of DTC

A

Environment associations - ionising radiation and iodine deficiency
Genetic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where are mutations often found in papillary carcinomas?

A

MAP kinase pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where are mutations often found in follicular carcinomas?

A

P13K/AKT pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where are mutations often found in anaplastic carcinoma?

A

MAP kinase/P13K/AKT/p53/ beta catenine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What mutations are associated with medullary thyroid cancer?

A

Multiple endocrine neoplasm type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the appearance of a papillary carcinoma

A

Usually a solitary nodule in the thyroid often cystic and may be calcified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the name given to the parts of a tumour that have calcified?

A

Psammoma bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the local effects of a papillary carcinoma?

A

Hoarseness, dysphagia, cough, dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where do papillary carcinomas usually spread to?

A

Lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If papillary carcinomas spread haematological where will it go to?

A

Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What disease is papillary carcinoma associated with?

A

Hashimoto’s thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the 10 year survival of papillary carcinoma?

A

95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What areas of the world have a higher incidence of follicular carcinoma?

A

Regions of iodine deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If a follicular carcinoma is minimally invasive what will it look like?
Follicular architecture, may have surrounding capsule but difficult to distinguish from adenoma
26
If a follicular carcinoma is widely invasive what will it look like?
More solid architecture, less follicular and more mitotic
27
How do follicular carcinomas usually spread?
Haematogenous
28
What is the 10 year survival of follicular carcinoma?
Ranges from 50-100%
29
Where do medullary thyroid carcinomas arise from?
C cells that secrete calcitonin
30
Describe the aetiology of medullary thyroid carcinoma
Young patients - MEN | 40-50 year olds - sporadic/familial
31
How will a sporadic MTC appear?
Solitary nodule
32
How will a familial MTC appear?
Multi-centric/bilateral due to C cell hyperplasia
33
Describe the histology of MTC
Composed of spindle/polygonal cells arranged in nests/trabeculae/follicles, necrosis, small cell morphology, often very aggressive
34
What is MTC often associated with?
Amyloid deposition - abnormal folded protein (calcitonin)
35
What is the typical presentation of an MTC?
Neck mass with local effects
36
What is the key risk associated with MTC?
Paraneoplastic syndrome
37
State the two checks that are important to determine the cause of MTC
- urinary metenephrines | - genetics
38
Describe anaplastic carcinoma
Undifferentiated aggressive tumours, usually in older patients with a history of DTC. Rapid growth, involvement of neck structures and death.
39
State two important questions in a suspected thyroid cancer history
- neck irradiation | - family history of thyroid cancer
40
What is the significance of the patient sticking out their tongue during examination?
Thyroglossal cyst will move - also will cause supra-hyoid midline swelling
41
What investigations should be carried out on a suspected solitary thyroid nodule?
TSH | Ultrasound +/- Fine needle aspiration
42
Describe the categories of USS FNA
``` Thy 1 - inadequate only blood cells seen Thy 2 - benign - U2 Thy 3 - atypical/follicular - U3 Thy 4 - probably malignant - U4 Thy 5 - malignant - U5 ```
43
Who is a low risk group?
Age <50 years old, tumour<4cm
44
How are low risk groups managed?
Lobectomy - aim to keep TSH low and monitor baseline thyroglobulin
45
Who is a high risk group?
Palpable lymph nodes, >50 years old, >4cm tumour
46
How are high risk groups managed?
Total thyroidectomy - keep TSH low, monitor thyroglobulin, may need to use radio iodine
47
What do thyroglobulin levels help indicate?
Increases help to diagnose recurrent disease
48
State the T categories of TNM
T1 - = 2cm T2 2-4cm T3 - >4cm T4a - any size extending beyond capsule within tracheal fascia T4b - advanced disease involves pre vertebral fascia
49
State the N categories of TNM
N0 - no lymph nodes N1a - regional lymph nodes N1b - cervical/retropharyngeal/superior mediastinal lymph nodes
50
What condition is thyroid lymphoma associated with?
Hashimoto's thyroiditis - B cell lymphoma
51
How does thyroid lymphoma present?
Rapidly expanding mass usually in women aged 70-80 years old
52
How is thyroid lymphoma diagnosed?
Core biopsy
53
What is the treatment for thyroid lymphoma?
Chemotherapy, radiotherapy, steroids
54
What are the investigations for a multi-nodular goitre?
Assess TSH | CT scan
55
What respiratory symptoms can a multi-nodular goitre cause and how can they be investigated?
Retrosternal extension/tracheal compression will cause stridor or choking when lying flat. Volume loops can help identify the cause of respiratory symptoms
56
How are multi-nodular goitres managed?
Most can be left alone Radioactive iodine if significant hyperthyroidism Surgery if respiratory problems/cancerous/impacting life
57
What are the three types of surgery for thyroid nodules?
- thyroid lobectomy with isthmusectomy - sub-total thyroidectomy - total thyroidectomy
58
What risk assessment tool is used for risk stratification?
Age Metastases Extent of primary tumour Size of primary tumour
59
Who is classed as a low risk?
Younger patients with no evidence of mets Older patients with an intrathyroidal papillary lesion or minimally invasive follicular lesion where the primary tumour is <5cm with no distant mets
60
What is the 20 year survival for low risk patients?
99%
61
Who is classed as high risk?
All patients with distant mets, extra thyroidal disease in papillary carcinoma or significant capsular invasion in follicular carcinoma. Primary tumour >5cm
62
What is the 20 year survival for high risk patients?
61%
63
What surgery is used for AMES low risk patients?
Lobectomy and isthmusectomy
64
Describe a thyroid lobectomy and isthmusectomy
The gland is exposed 2-3cm above the sternal notch by separation of the strap muscles. The lobe is mobilised by diving the vessels supplying each part
65
Describe a sub/total thyroidectomy
?
66
What lymph node surgery is carried out in papillary tumours?
Central compartment clearance and lateral lymph node sampling
67
What lymph node surgery is carried out in follicular cancer?
Central node clearance
68
What should be checked within 24 hours of a thyroid operation?
Calcium - replacement initiated if levels are below 2mmol/l, if below 1.8 IV calcium is required
69
Name the investigation carried out usually 3-6 months post thyroid operation
Iodine scan
70
Describe the radio iodine scan
TSH >20 for best results Monday/Tuesday - rhTSH injection Wednesday - Iodine injection Friday - Scan
71
What is the purpose of a radio iodine scan?
In order to view any residual thyroid tissue
72
If residual tissue is present on iodine scan what is done?
Thyroid remnant ablation
73
Describe thyroid remnant ablation
Patient is admired to a lead lined room with main sewage, pre-treated with rhTSH and 2-3 units of iodine are administered. Stay in the room until they are less radioactive (80% excreted in first 24 hours)
74
What is the aim of thyroid remnant ablation?
Suppress TSH and destroy remnant cells and mircofoci
75
What are the short and long term side effects of remnant ablation?
Short term - sialadenitis | Long term - increased incidence of AML

Endocrine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions