Thyroid nodular management

Question 1

Causes of benign thyroid nodule

Answer 1

Cyst
Colliod nodule
Benign follicular adenoma
Hyperplastic nodule

Question 2

In a benign thyroid nodule what could result in pain?

Answer 2

A intra thyroid bleed into a cyst

Question 3

What is the first line test after clinical examination and bloods?

Answer 3

USS-FNA

Ultra sound with fine needle aspiration

Question 4

USS-FNA

Thy 1

Answer 4

Inadequate

Question 5

USS-FNA

Thy 2

Answer 5

Benign

Question 6

USS-FNA

Thy 3

Answer 6

Atypical

Question 7

USS-FNA

Thy 4

Answer 7

Probably malignant

Question 8

USS-FNA

Thy 5

Answer 8

Malignant

Question 9

What signifies a low risk patient?

Answer 9

Aged <50
Tumour <4cm
Baseline Thyroglobulin
TSH lower range of normal

Question 10

In a low risk patient what is the treatment

Answer 10

Lobectomy

Question 11

What signifies a high risk patient?

Answer 11

TSH < 1mU/L

Question 12

In a high risk patient what is the treatment

Answer 12

Total thyroidectomy

Question 13

T1

Answer 13

Tumour under <2cm

Question 14

T2

Answer 14

Tumour under 4cm but > 2 cm

Question 15

T3

Answer 15

Tumour greater than 4cm but limited to thyroid and immediate tissue within thyroid capsule

Question 16

What tissues could be invaded whilst still classified as T3

Answer 16

Sternothyroid muscle

Question 17

T4a

Answer 17

Moderately advanced tumour

Any size of tumour extending beyond thyroid capsule invading any soft tissue

Question 18

T4b

Answer 18

Very advanced tumour
Invades prevertebral fascia
Encases carotid artery or mediastinal vessels

Question 19

N0

Answer 19

No regional lymph metastasis

Question 20

N1

Answer 20

Regional lymph metastasis

Question 21

N1a

Answer 21

Metastasis to level VI pre/para tracheal lymphnodes

Question 22

N1b

Answer 22

Metastasis to Uni/Bi/Contra lateral lymph

Cervical, retropharyngeal and superior mediastinal also affected

Question 23

M0

Answer 23

No distant metastasis

Question 24

M1

Answer 24

Distant metastasis

Question 25

What signifies a high risk group once cancer diagnosed?

Answer 25

T3 or higher

Question 26

Treatment for high risk cancer group?

Answer 26

Total thyroidectomy | Consider radioactive iodine

Question 27

What is RAI treatment

Answer 27

Radioactive iodine isotopes are taken up by the thyroid from where the isotope kill thyroid cells

Question 28

Follow up in papillary and follicular cancer

Answer 28

TSH and thyroglobulin blood tests every 6 months for 5 years then annually for 5 more.

Question 29

What can be used as a tumour cell marker in thyroid cancer?

Answer 29

Thyroglobulin

Question 30

What monitored levels of TSH are desirable post treatment?

Answer 30

0.4-4 mU/L

Question 31

Thyroid lymphoma

Answer 31

Background of autoimmune hypothyroidism Rapid growth in thyroid Women aged 70-80

Question 32

What is used for diagnosis in thyroid lymphoma

Answer 32

Core biopsy

Question 33

Treatment in thyroid lymphoma

Answer 33

Chemotherapy Deep X ray therapy Steroids

Question 34

What is the chemotherapy agent used in thyroid lymphoma ?

Answer 34

R-CHOP

Question 35

What types of medullary thyroid cancer are there?

Answer 35

Sporadic Familial non MEN Familia MEN2a(B)

Question 36

What treatment should be considered if familial history on MEN2a(B)

Answer 36

Prophylactic thyroidectomy as a child

Question 37

In a multi nodular thyroid goitre what two things should be assessed?

Answer 37

Function- TSH and Thyroglobulin | Structure - CT scan

Question 38

Treatment in multinodular goitre

Answer 38

Most leave alone Radioactive Iodine if hyperthyroidism Surgery is structural issue

Question 39

When is surgery indicated in multinodular goitre?

Answer 39

``` Lifestyle interference Possibility of cancer Tracheal compress <7mm if symptomatic Audible stridor Other respiratory issues ```

Question 40

Why is Fine needle aspiration not helpful for diagnosing follicular carcinoma

Answer 40

As unable to indicate whether the capsule has been broken, so distinguishing if its minimally or widely invasive. The two have different treatment strategies and prognosis

Question 41

What can be used as a tumour marker in medullary thyroid cancer?

Answer 41

Calcitonin | MTC is cancerous C-Cells