thyroid nodules

Question 1

what are some benign thyroid nodules

Answer 1

• cyst
• colloid nodule
• benign follicular adenoma
• hyperplastic nodule

Question 2

what are some malignant thyroid nodules

Answer 2

• papillary thyroid nodule
• follicular thyroid carcinoma
• medullary thyroid carcinoma

Question 3

presentation of a thyroid nodule

Answer 3

• neck irradiation
• family history of thyroid cancer
• neck nodes
• hoarseness
• nodule moves on swallowing
• shouldn’t be painful

Question 4

investigations for thyroid cancer

Answer 4

• TSH blood test

- USS-FNA

Question 5

staging of fine needle aspiration uss

Answer 5

Thy1 - inadequate
Thy2 U2 - benign
Thy3 U3 - atypical
Thy4 U4 - prob malignant 
Thy5 U5 - malignant

Question 6

who gets papillary thyroid cancer

Answer 6

younger patients

-spread is lymph nodes and lungs

Question 7

who gets follicular

Answer 7

middle aged patients

-spread by blood

Question 8

who gets medullary

Answer 8

sporadic

Question 9

what classifies a T1, T2, T3, T4a, T4b cancer

Answer 9

T1 - <= 2cm
T2 - > 2cm but <=4cm
T3 - >4cm limited to thyroid
T4a - any size tumour extending beyond thyroid
T4b - tumour invad or prevertebral fascia or encases carotid artery or mediastinal vessels

Question 10

treatment for low risk group thyroid cancer

Answer 10

thyroid lobectomy

Question 11

treatment for high risk group (T3 or greater)

Answer 11

• total thyroidectomy

- consider radio-active iodine

Question 12

what does diagnosis depend on in follicular cancer

Answer 12

invasion of the capsule or vascular invasion

Question 13

how is a minimally invasive follicular thyroid cancer treated

Answer 13

by thyroid lobectomy

Question 14

when would you consider a total thyroidectomy

Answer 14

significant vascular invasion

Question 15

presentation of a thyroid lymphoma

Answer 15

• background of auto-immune hypothyroidism
• rapid onset mass in thyroid
• females aged 70-80

Question 16

what are the types of medullary thyroid cancer

Answer 16

• sporadic
• familial non-MEN
• familial MEN (MEN2a)

Question 17

tumour marker for medullary thyroid carcinoma

Answer 17

calcitonin

Question 18

what should be screened for in MEN2a

Answer 18

phaechromatocytoma

Question 19

treatment for medullary carcinoma

Answer 19

thyroidectomy and node clearance

Question 20

what is seen on CT scan with a multinodular goitre

Answer 20

• retrosternal extension

- tracheal compression

Question 21

TSH in a multinodular goitre

Answer 21

usually normal, maybe slightly suppressed

Question 22

treatment for a multinodular goitre

Answer 22

• most can leave alone
• RAI if sig hyperthyroid
• surgery if structural problem

Question 23

who do you offer surgery for restrosternal goitres

Answer 23

patients with

• lifestyle interfering symptoms
• possibility of cancer
• significant tracheal compression if symptomatic

Question 24

what is offered if there is potential of other respiratory causes of breathing difficulties

Answer 24

tracheal flow loops

Question 25

what is treatment for a thyroid lymphoma

Answer 25

- core biopsy - steroids - R-CHOP chemotherapy - radiotherapy