THYROID

Question 1

MEN 1 gene? Located on what Chr?

Answer 1

Menin. AD gene located on Chr 11.

Question 2

First abnormality typically detected for MEN 1.

Answer 2

hyperCa 2/2 hyperPTH (nephrolithiasis)

Question 3

Risk thyroid cancer highest in young vs. old, men vs. female?

Answer 3

highest in young AND old, 2x greater risk in men (excision indicated in men >60yo)

Question 4

Genetic mutation associations: RET

Answer 4

familial medullary thyroid CA

Question 5

Genetic mutation associations: PAX-8/PPARgamma

Answer 5

follicular thyroid CA

Question 6

Genetic mutation associations: p53

Answer 6

anaplastic

Question 7

Genetic mutation associations: BRAF

Answer 7

papillary

Question 8

Mgmt thyroid lymphoma

Answer 8

chemotherapy (do not need surgery unless compressive sxs)

Question 9

Mgmt diffuse large B-cell lymphoma

Answer 9

CHOP (cytoxan, hydroxy doxodubicin, oncovin, prednisone) + radiation

Question 10

Bethesda criteria (6)

Answer 10

for FNA results

1. benign = repeat exam in 6-12mo with US
2. non-dx (suspicious US, benign FNA; discordinant) = repeat FNA
3. follicular cell of indeterminate significance = repeat FNA
4. follicular neoplasm = lobectomy
5. suspicious for malignancy = lobectomy vs. total thyroidectomy
6. malignant = lobectomy vs. total thyroidectomy

Question 11

MC type thyroid cancer

Answer 11

papillary

Question 12

Does lymphatic spread affect prognosis of papillary thyroid cancer?

Answer 12

NO. Local invasion does.

Question 13

Path: papillary thyroid cancer

Answer 13

• psammoma bodies

- orphan annie nuclei

Question 14

Why total thyroidectomy for papillary thyroid cancer?

Answer 14

1. removal of multifocal disease (common 30%), even if cannot see
2. preparation for RAI therapy
3. so can use thyroglobulin levels to test for recurrence

Question 15

Germline mutations related to medullary thyroid cancer

Answer 15

1. MEN 2A (RET)
2. MEN 2B (RET)
3. familial medullary thyroid cancer

Question 16

Serum markers surveillance for medullary thyroid cancer

Answer 16

calcitonin (pentagastrin-stimulated peak plasma calcitonin) + CEA levels q6mo for 1 year, then annually

Question 17

Anatomical variance associated w/ non-recurrent RIGHT laryngeal nerve

Answer 17

aberrant RIGHT subclavian artery (arteria dosoria)

Question 18

Serum marker surveillance for papillary thyroid cancer

Answer 18

thyroglobulin

Question 19

MC sxs of high level calcitonin in blood

Answer 19

diarrhea

Question 20

MEN2A: what age need prophylactic thyroidectomy?

Answer 20

6yo

Question 21

MEN2B: what age need prophylactic thyroidectomy

Answer 21

<2yo

Question 22

Superior thyroid artery runs adjacent to what nerve?

Answer 22

superior laryngeal nerve

Question 23

Inferior thyroid artery runs adjacent to what nerve?

Answer 23

recurrent laryngeal nerve (either anterior or posterior)

Question 24

Venous drainage of superior vs. middle vs. inferior thyroid veins

Answer 24

superior + middle -> IJ vein

inferior -> innominate veins

Question 25

Elevated calcitonin level >400, think...?

Answer 25

medullary thyroid cancer

Question 26

Leukocytosis + normal TFTs in setting of tender, enlarged nodule... think?

Answer 26

acute suppurative thyroiditis

Question 27

Mgmt acute suppurative thyroiditis

Answer 27

US-guided FNA w/ gram stain and Cx + Abx +/- drainage

Question 28

MC bacteria acute suppurative thyroiditis

Answer 28

staph aureus + strep pyogenes

Question 29

Most accurate and cost-effective assessment of thyroid nodules

Answer 29

FNA biopsy (PPV 97-99%)

Question 30

MEN 1 malignancies

Answer 30

- pituitary adenoma - parathyroid hyperplasia - pancreatic tumor (MC gastrinoma)

Question 31

MEN 2A malignancies

Answer 31

- parathyroid hyperplasia - medullary thyroid CA - pheo

Question 32

MEN 2B maligancies

Answer 32

- medullary thyroid CA - pheo - mucosas neuromas + marfanoid body habitus

Question 33

Sxs postpartum thyroiditis

Answer 33

thyrotoxicosis (anxiety, palpitations, insomnia) -> hypothyroidism (can be Tx levothyroxine for 6-9mo, tapered)

Question 34

Suspicious sonographic features of thyroid nodule (5)

Answer 34

- hypoechoic - microcalcifications - increased central vascularity - infiltrative margins - taller than wider in transverse palne

Question 35

Size indication for thyroid nodule to get FNA

Answer 35

>1cm w/ suspicious US features OR >1.5cm wo features

Question 36

If AUS or FLUS... mgmt?

Answer 36

if low malignancy risk -> repeat FNA | if w/ RF -> lobectomy

Question 37

Fu for indeterminate FNA for follicular neoplasm + benign gene expression classifier (GEC)

Answer 37

repeat clinical exam + US at 1 year

Question 38

Operative mgmt pt w/ medullary thyroid carcinoma on FNA, but negative cervical US for nodes

Answer 38

total thyroidectomy + central LN dissection (bc high rate CLN involvement and high US false-neg)

Question 39

Who needs radioactive iodine Tx after total thyroidectomy?

Answer 39

- tumor 2-4cm - vascular invasion - anti TG Ab - TG <5 * also allows following TG levels to assess recurrence

Question 40

How to assess for recurrence of follicular thyroid CA?

Answer 40

follow TG levels

Question 41

What size thyroid nodule requires evaluation with FNA?

Answer 41

- any solid thyroid nodule >/= 1.5cm size | - solid nodule >/= 1cm + suspicious features

Question 42

Suspicious features of thyroid nodule on US

Answer 42

- hypoechoic - microcalcifications - infiltrative margins - taller than wider in transverse plane

Question 43

Tx after partial thyroidectomy for <1cm papillary thyroid CA

Answer 43

Thyroid hormone to suppress TSH + f/u with US

Question 44

For which papillary thyroid carcinoma is partial thyroidectomy (lobectomy) okay?

Answer 44

- small, encapsulated (noninvasive) <1cm diameter - age <45 - negative nodes

Question 45

Damage to the external branch of the superior laryngeal nerve results in...?

Answer 45

affects voice pitch (motor innervation to cricothyroid muscle, which tilts larynx during speaking)

Question 46

Damage to recurrent laryngeal nerve results in...?

Answer 46

airway compromise (innervates posterior cricoarytenoid muscles)

Question 47

What size solid thyroid nodule requires evaluation with FNA?

Answer 47

>/= 1.5cm | Eval >/= 1cm only if + suspicious features