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The Endocrine System > Thyroid Nodules > Flashcards

Thyroid Nodules Flashcards

1
Q

What percentage of women suffer from solitary thyroid nodules?

A

5%

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2
Q

Of the women who suffer from solitary thyroid nodules, what percentage suffer from malignant thyroid nodules?

A

5%

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3
Q

Which types of solitary thyroid nodules are benign?

A
  1. Thyroid cysts
  2. Colloid nodules
  3. Benign follicular adenoma
  4. Hyperplastic nodules
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4
Q

Which types of malignant thyroid nodules are malignant?

A
  1. Papillary thyroid carcinoma
  2. Follicular thyroid carcinoma
  3. Medullary thyroid carcinoma
  4. Lymphoma
  5. Poorly differentiated
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5
Q

What percentage of malignant solitary thyroid nodules are papillary thyroid carcinomas?

A

80%

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6
Q

Follicular thyroid carcinoma are cancers of which cells?

A

Parafollicular C cells

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7
Q

How are follicular thyroid carcinomas spread?

A

Haematogenous spread

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8
Q

How can it be confirmed that a thyroid nodule is within the thyroid?

A

If it moves on swallowing it is invested in pretracheal fascia

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9
Q

What are 2 essential questions to ask in a history for a solitary thyroid nodule?

A
  1. Previous neck of irradiation
  2. Family history of thyroid cancer
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10
Q

What are two keys things to look for on examination for a solitary thyroid nodule?

A
  1. Neck nodes
  2. Hoarseness (and bovine cough)
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11
Q

Why are neck nodes a major worry if found in the context of a solitary thyroid nodule?

A

Lymph node spread of a papillary thyroid carcinoma

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12
Q

Why is hoarseness and a bovine cough a worry if found on examination in the context of a solitary thyroid nodule?

A

Recurrent laryngeal nerve palsy may indicate an aggressive thyroid cancer

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13
Q

What is a bovine cough?

A

A wheezing type cough caused due to inability to close the rima glottidis

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14
Q

Which three investigations would be undertaken primarily if there is a solitary thyroid nodule?

A
  1. TSH
  2. USS
  3. FNA
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15
Q

Why may a core biopsy be superior to a FNA of a solitary thyroid nodule?

A

It gives more idea about morphology and structure

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16
Q

If TSH is elevated when testing for a solitary thyroid nodule, what may this suggest?

A

Hypothyroidism

Autoimmune thyroiditis

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17
Q

If TSH levels are suppressed when testing a solitary thyroid nodule, what may be the cause an which inestigation would then be a good idea?

A

Solitary toxic adenoma

Isotope scan

(the tumour does not take up the isotope, but the rest of the gland does)

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18
Q

What is the normal range for TSH?

A

0.4 - 4mU/L

19
Q

What constitutes a low risk patient with a differentiated thyroid cancer?

A

Age < 50

Tumour < 4cm

20
Q

What is the treatment for a low risk patient with a differentiated thyroid cancer?

A

Lobectomy

21
Q

What is the treatment for a high risk patient with a differentiated thyroid cancer?

A

Total thyroidectomy

22
Q

What levels is the central neck?

A

L6/7

23
Q

What levels is the lateral neck?

A

L2-L5

24
Q

To which level in the neck do most thyroid cancers spread?

A

L3/4

(lateral neck dissection required)

25
Q

Why is it recommended to keep TSH levels < 1 mU/L in the presence of a differentiated thyroid carcinoma?

A

TSH stimulates follicular cells which may worsen the tumour

26
Q

What percentage of malignant thyroid cancers do follicular thyroid cancers comprise?

A

10%

27
Q

The diagnosis of a follicular thyroid cancer depends on if it has invaded the capsule or had vascular invasion. What is the tumour called before this stage?

A

Benign follicular adenoma

28
Q

What is the most common type of follicular thyroid cancer?

A

Minimally invasive thyroid follicular carcinoma

29
Q

Due to the haematogenous spread of follicular thyroid carcinoma, what are the two most common places for metastases?

A
  1. Bone
  2. Liver
30
Q

What are the treatment options for minimally invasive thyroid follicular carcinoma?

A

Thyroid lobectomy

Total thyroidectomy (if significant vascular invasion)

31
Q

A thyroid lymphoma often develops on a background of which condition?

A

Autoimmune hypothyroidism

32
Q

Was is the onset like for a thyroid lymphoma?

A

Rapid

33
Q

Which type of people are likely to be affected by thyroid lymphoma?

A

Females 70-80

34
Q

What are the treatment options for thyroid lymphoma?

A
  1. Chemotherapy
  2. Radiotherapy
  3. Steroids (for the acutely unwell)
35
Q

What is secreted by a medullary thyroid carcinoma?

A

Calcitonin

(this can be used as a tumour cell marker)

36
Q

How can meduallary thyroid carcinoma be diagnosed?

A

Fine needle aspiration

37
Q

What are the 4 types of medullary thyroid carcinoma?

A
  1. Sporadic
  2. Familial non-MEN
  3. Familial MEN
  4. Familial MEN2a and b
38
Q

If a child is suspected to have familial MEN what treatment may be considered?

A

Prophylactic thyroidectomy

39
Q

What is MEN?

A

Multiple endocrine neoplasia

(Wermer syndrome)

40
Q

MEN2a is a condition which is associated with which other conditions?

A
  1. Phaeochromocytoma
  2. Medullary thyroid carcinoma
  3. Hyperparathyroidism
41
Q

What is phaeochromocytoma?

A

A tumour of the adrenal gland which causes too much adrenaline/noradrenaline release

42
Q

MEN1 commonly affects which endocrine glands?

A
  1. Pituitary
  2. Parathyroid
  3. Pancreas

The 3 Ps

43
Q

How can the function of the thyroid in multinodular goitre tested and what is the expected result?

A

TSH

Potentially slightly supressed

44
Q

What are the treatment options for multinodular goitre?

A
  1. Leave alone
  2. Radioactive iodine (significant hyperthyroidism)
  3. Surgery (structural issues)

The Endocrine System (35 decks)

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