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thyroid nodules Flashcards

1
Q

thyroid masses

A

> 4cm

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2
Q

thyroid nodules

A

1 - 4 cm

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3
Q

small thyroid lesions

A

( < 1cm)
radiologically detected as they are clinically undetectable
if cancerous, are termed “microcarcinomas” when <= 10mm

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4
Q

what do follicular cells “thyrocytes” produce

A

thyroglobulin

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5
Q

what do para-follicular cells “c-cells” produce

A

calcitonin

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6
Q

what do colloid / thyroglobulin store

A

iodination in colloid
thyroxine

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7
Q

are lymphocytes infiltrative ?

A

true (any lymphocytes are infiltrative)

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8
Q

how common are thyroid nodules amongst adult UK population ?

A

5% females
1% males

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9
Q

what are the presentation of thyroid nodules ?

A

symptomatic
incidental finding (on a scan)

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10
Q

what percentage of thyroid nodules are benign / malignant ?

A

95% benign
5% malignant
(90% are differentiated thyroid cancers)

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11
Q

what percentage of cancers do thyroid cancers account for ?

A

1% of cancers (20th most common)

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12
Q

are thyroid cancers most common form of endocrine neoplasm ?

A

true

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13
Q

examination for thyroid nodules

A

inspection
feel neck triangles / lymph nodes
feel thyroid
tongue protuberance
drinking water

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14
Q

what inspection during thyroid nodule examination ?

A

eyes, neck

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15
Q

what areas of neck triangle / lymph nodes to feel

A

anterior vs posterior
levels: 2,3,4,5,6

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16
Q

thyroid function blood tests

A

TSH
calcitonin
thyroglobulin
thyroglobulin antibody
PTH (parathyroid hormone)

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17
Q

is TSH always done for thyroid function blood tests ?

A

yes

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18
Q

calcitonin always done for thyroid function ?

A

not routinely (only in history or cytology suggestive of MTC)

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19
Q

is thyroglobulin always done for thyroid function ?

A

no - only for thyroid cancer surveillance

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20
Q

is thyroglobulin antibody always done ?

A

no - only for thyroid cancer surveillance

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21
Q

is PTH (parathyroid hormone) always done ?

A

no - only if suspecting parathyroid mass

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22
Q

what is used for thyroid imaging

A

ultrasound
radioisotope scan
CT

23
Q

what is U1 grading in thyroid imaging ?

24
Q

U2 grading

25
U3 grading
indeterminate / equivocal
26
U4 grading
suspicious
27
U5 grading
malignant
28
when do you go for a radioisotope scan (if TSH supressed - <0.4mlU/L)
to detect cold nodule hot nodule is toxic adenoma
29
when do you use CT for thyroid imaging
reserved for local cancer invasion or advanced cases
30
thyroid cyctology
ultrasound assisted (historically free-hand if >4cm)
31
when do you proceed to FNAC
any U4 / U5 U3/4 U3 > 1.5
32
**thyroid cytology
do I need to know about the scoring system in UK (RCP)
33
non-neoplastic thyroid nodules
multi-nodular goitre MNG (common) hyperplastic nodule colloid
34
non-cancerous thyroid neoplasms
toxic adenoma non-invasive follicular thyroid neoplasm papillary-like nuclear features (NIFTP) pre-cancer
35
differentiated thyroid cancers (90% of thyroid cancer)
papillary thyroid cancers 80% - various types follicular 15% - various types hurthle cell cancer 5%
36
primary thyroid lymphoma
need core biopsy
37
anaplastic thyroid cancer
<1% (very aggressive, 2 tayside cases a year)
38
medullary thyroid cancer
1%
39
metastasis to thyroid
(e.g. renal cancer)
40
how to manage benign symptomatic nodules
may warrant surgery (e.g. compressive or toxic)
41
how to manage high risk cancer - Thy4/Thy5 discussed at MDT to decide
hemithyroidectomy or total thyroidectomy + radioactive-iodine
42
how to manage low risk cancer - Thy3a or Thy3f
diagnostic hemi-thyroidectomy or repeat FNA
43
how to manage surgical pathology
benign pathology with description or... cancer type w/ TNM staging
44
if diagnostic hemi-thyroidectomy showed cancer:
surveillance completion thyroidectomy + radioactive iodine
45
(complications of thyroidectomy) seroma
common & settles (<5%)
46
(complications of thyroidectomy) superficial haematoma
common & settles. consider evacuation if large
47
(complications of thyroidectomy) hypocalcaemia
only after total thyroidectomy (parathyroid function)
48
(complications of thyroidectomy) wound infection
uncommon (<5%) if in doubt give antibiotics
49
(complications of thyroidectomy) scar
abnormal scarring uncommon (<5%) . body image/psychology affecrs QOL
50
(complications of thyroidectomy) stridor
deep haematoma causing laryngeal oedema. rare (<1%)
51
(complications of thyroidectomy) RLN injury
voice change & swallow problems. a spectrum
52
(complications of thyroidectomy) chyle leak
possible with left level vi lymph node dissection
53
(complications of thyroidectomy) other nerve injuries

endocrine (15 decks)

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