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12 Cards in this Set
- Front
- Back
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thyroid nodules
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-very common
-as you get older the thyroid grows, nodules grow (can become autonomous) -by the time a male is 50, close to 50% will have nodules -women get thyroid conditions much more than men -worried about cancer (not common) -and enlarged parathyroid gland can look like a nodule -if one lobe is removed, can appear to be a nodule and the other half can be enlarged |
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a single nodule DDX
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1. primary thyroid cancer
2. metastasis from distant primary 3. lymphoma, lymphsarcoma 4. benign adenoma: MOST COMMON 5. cysts: MOST COMMON |
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primary thyroid cancer types
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1. Papillary: MOST COMMON
2. medullary 3. follicular 4. anaplastic -all of these cancers generally DO NOT take up iodine --> cold nodule on scan! |
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papillary thyroid cancer
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-most common
-50-60% of thyroid cancers -fingerlike projections of cells -benign --> easy to cure, grows slowly, usually spreads through lymph -associated with radiation therapy -10 yr survival well over 90% -present with nodules in neck or enlarged lymph nodes |
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medullary thyroid cancer
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-from calcitonin producing cells
-can be familial -MEN syndromes -can do genetic testing -calcitonin lowers the calcium to some extent |
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follicular
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-similar to papillary
-slightly more malignant than papillary -spreads by blood stream -may see a pulmonary MET or pathologic hip fx -present with nodules in neck -survival rate is 80% for most unless there has been a lot of invasions |
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anaplastic thyroid cancer
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-undifferentiated = horrible disease
-malignant -spreads through lymph, blood, etc -VERY AGGRESSIVE -survival very poor- 50% dead within 6 months -big mass, fixed, feel lymph nodes, rock hard -extremely unusual in young people |
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fine needle biopsy
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-first thing that should be done with a nodule to make a definitive diagnosis; tells you whether or not it is benign (may have to prep the patient and do some TFTs first)
-Risks: 1. bleeding 2. infx 3. main concern is you may miss the nodule if you do not have U/S guidance |
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characteristics of thyroid cancer
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o Histology
o Relative Incidence o Age Distribution o Sex Distribution o History of irradiation o Characteristics of Growth and Spread o Survival o Clinical Presentation o RAI Uptake o Associated Disease |
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factors in decision making
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1. age
2. sex 3. hx of irradiation 4. isolated or new nodule 5. physical examination 6. RAI scan |
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features favoring a benign thyroid nodule
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1. FH of benign nodule or hashimotos
2. ssx of hyper/hypothyroid 3. soft, smooth, mobile nodule 4. multi-nodular goiter without predominant nodule 5. WARM nodule on scan 6. simple cyst on u/s |
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suspicion of malignant nodule
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1. age <20 or >70; male
2. new onset of swallowing difficulties 3. irradiation during childhood 4. firm, irregular, fixed 5. presence of cervical LAD 6. previous hx of thyroid cacer 7. COLD nodule on scan 8. solid or complex on u/s |
