Year 2 Surgery: Thyroid Surgery and Cancer
48 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is a differentiated thyroid cancer?

  • Lymphoma of the thyroid
  • Medullary carcinoma of the thyroid
  • Papillary carcinoma of the thyroid (correct)
  • Anaplastic carcinoma of the thyroid

    • What is the commonest clinical presentation of thyroid cancer?

  • Exophthalmos (bulging eyes)
  • Hoarse voice
  • A solitary thyroid nodule (correct)
  • Uniformly enlarged goiter

    • Which of the following is an indication for thyroid surgery?

  • Cosmesis
  • Allergic reactions to thyroid medication
  • Thyroid cancer (correct)
  • Toxic thyroid nodule (correct)

    • What is one of the indications for thyroidectomy in benign disease?

    <p>Compression of adjacent structures</p> Signup and view all the answers

    Which nerve is at risk of being injured during thyroid surgery?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    Which factor is associated with a poor prognosis in thyroid cancer?

    <p>Soft tissue invasion</p> Signup and view all the answers

    Damage to which nerve is most likely to result in a hoarse voice?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    What classification describes a lesion with cytological atypia of uncertain significance?

    <p>Thy 3a</p> Signup and view all the answers

    Which of the following conditions is most likely to warrant a total thyroidectomy?

    <p>Papillary carcinoma with aggressive features</p> Signup and view all the answers

    Which condition is NOT an indication for thyroidectomy in benign disease?

    <p>Phaeochromocytoma</p> Signup and view all the answers

    Which complication is commonly associated with thyroid surgery?

    <p>Hypothyroidism</p> Signup and view all the answers

    Which type of tumor is indicated by the RET gene mutation associated with MEN 2b?

    <p>Phaeochromocytoma</p> Signup and view all the answers

    Radioactive iodine is primarily used in the treatment of which condition?

    <p>Thyroid cancer</p> Signup and view all the answers

    What does a Thy 5 classification indicate in thyroid pathology?

    <p>Malignant</p> Signup and view all the answers

    In MEN 2a, which type of tumor is associated with the mutation of the RET gene?

    <p>Medullary thyroid carcinoma</p> Signup and view all the answers

    Which imaging study is typically performed to evaluate thyroid nodules?

    <p>Ultrasound</p> Signup and view all the answers

    Which thyroid cancer is most commonly associated with a firm nodule and increased risk in patients aged 60 or older?

    <p>Papillary Thyroid Carcinoma</p> Signup and view all the answers

    What is a common risk factor for Follicular Thyroid Carcinoma?

    <p>Iodine deficiency</p> Signup and view all the answers

    What is a characteristic feature of Medullary Thyroid Carcinoma?

    <p>Elevated calcitonin levels</p> Signup and view all the answers

    Which thyroid cancer has the highest mortality rate?

    <p>Anaplastic Thyroid Cancer</p> Signup and view all the answers

    What is the predominant demographic affected by Papillary Thyroid Carcinoma?

    <p>Females aged 30-50</p> Signup and view all the answers

    Which presentation is common for Medullary Thyroid Carcinoma?

    <p>Cervical lymphadenopathy</p> Signup and view all the answers

    What type of metastasis is typically associated with Follicular Thyroid Cancer?

    <p>Hematogenous spread</p> Signup and view all the answers

    What is a recommended approach for managing Anaplastic Thyroid Cancer?

    <p>Palliative care</p> Signup and view all the answers

    What anatomical structure is the recurrent laryngeal nerve located near during thyroid surgery?

    <p>Between the trachea and esophagus</p> Signup and view all the answers

    Which condition is least likely to require surgical intervention among the listed options?

    <p>Uniformly enlarged goiter</p> Signup and view all the answers

    Which nerve primarily innervates the cricothyroid muscle?

    <p>External laryngeal nerve</p> Signup and view all the answers

    Which of these conditions is considered a benign thyroid pathology?

    <p>Follicular adenoma</p> Signup and view all the answers

    What is a typical symptom indicative of damage to the recurrent laryngeal nerve?

    <p>Loss of voice</p> Signup and view all the answers

    What factor is NOT typically associated with poor prognosis in thyroid cancer cases?

    <p>Gender</p> Signup and view all the answers

    Which type of thyroid cancer is known for having a higher rate of metastasis?

    <p>Anaplastic carcinoma</p> Signup and view all the answers

    In what scenario might treatment with radioactive iodine be considered?

    <p>After total thyroidectomy for thyroid cancer</p> Signup and view all the answers

    Which of the following symptoms is often associated with MEN 2b aside from Medullary Thyroid Carcinoma?

    <p>Ganglioneuromas</p> Signup and view all the answers

    What does a Thy 4 classification signify in thyroid pathology?

    <p>Suspicious of malignancy</p> Signup and view all the answers

    Which of the following is a recognized poor prognostic factor for thyroid cancers?

    <p>Soft tissue invasion</p> Signup and view all the answers

    In the context of benign thyroid disease, which of the following is NOT a reason for thyroidectomy?

    <p>Controlled thyrotoxicosis</p> Signup and view all the answers

    What is the approximate percentage of benignness associated with a Thy 3a classification?

    <p>90%</p> Signup and view all the answers

    Which of the following conditions is likely to lead to thyroid surgery based on benign indications?

    <p>Toxic adenoma non-responsive to medication</p> Signup and view all the answers

    What imaging technique is typically performed alongside clinical evaluation to assess thyroid nodules?

    <p>Ultrasound assessment</p> Signup and view all the answers

    Which factor is NOT included among the poor prognostic factors for papillary thyroid cancer?

    <p>Small tumour size</p> Signup and view all the answers

    What is the peak onset age for Follicular Thyroid Cancer?

    <p>40-60 years</p> Signup and view all the answers

    Which type of thyroid cancer is characterized by the production of calcitonin?

    <p>Medullary Thyroid Carcinoma</p> Signup and view all the answers

    Which clinical feature is associated with an increased risk of malignancy in thyroid nodules?

    <p>Firmness on palpation</p> Signup and view all the answers

    Which thyroid cancer is known for having an aggressive nature with a mortality rate approaching 100%?

    <p>Anaplastic Thyroid Carcinoma</p> Signup and view all the answers

    What is a characteristic feature of the spread of Papillary Thyroid Carcinoma?

    <p>Spread through lymphatics</p> Signup and view all the answers

    What risk factor is specifically associated with Follicular Thyroid Carcinoma?

    <p>Iodine deficiency</p> Signup and view all the answers

    Which group of patients is most likely to develop Medullary Thyroid Carcinoma as part of a syndrome?

    <p>Patients with familial predisposition such as MEN-2</p> Signup and view all the answers

    Which of the following is NOT a typical site for metastasis of Follicular Thyroid Carcinoma?

    <p>Spleen</p> Signup and view all the answers

    Study Notes

    Thyroid Surgery - Year 2 Surgery

    • Course Year: 2024-2025
    • Class: Year 2
    • Learning Objectives:
      • Recall thyroid gland anatomy, surrounding structures, and vascular supply.
      • Discuss lobectomy versus total thyroidectomy indications.
      • Discuss radioactive iodine's role in thyroid cancer management.
      • Describe surgical approach, complications, and recent advancements.

    Thyroid Cancer - Differential Diagnosis

    • Differentiated Thyroid Cancers:
      • Papillary carcinoma
      • Follicular carcinoma
    • Other Thyroid Cancers:
      • Medullary carcinoma
      • Anaplastic carcinoma
      • Lymphoma
      • Sarcoma
      • Metastasis (breast, colon, renal, melanoma)

    Thyroid Nodule - Differential Diagnosis

    • Vast Majority of thyroid nodules are benign.
    • Benign:
      • Multinodular goitre
      • Follicular adenoma
      • Thyroglossal cyst
      • Graves disease
      • Colloid goitre
      • Thyroiditis
    • Malignant:
      • Papillary carcinoma
      • Follicular carcinoma
      • Medullary carcinoma
      • Anaplastic carcinoma
      • Lymphoma
      • Metastatic cancer (rare)

    Papillary Thyroid Cancer

    • Peak onset: 30-50 years
    • Female to Male ratio: 3:1
    • Risk factors:
      • Radiation exposure
      • Family history
    • Spread: Primarily through lymphatics
    • Rare Metastasis: Lung, bone, (less often brain, kidneys, liver)
    • Important note: Peak onset between 30 and 50 years of age, with a female-to-male ratio of 3:1

    Follicular Thyroid Cancer

    • Second most common: Thyroid cancer
    • Peak onset: 40-60 years
    • Female to Male ratio: 3:1
    • Risk factors:
      • Radiation exposure
      • Family history
      • Iodine deficiency
    • Spread: Primarily via hematogenous route (blood)
    • Metastases: Bones (lytic lesions), lungs, brain, liver, bladder, skin. Some metastases can be hormonally active (hyperthyroidism).
      • Important note: The peak onset is in the 40-60 year age range, with a 3:1 female to male ratio. Risk factors include radiation exposure, family history, and iodine deficiency. Metastatic spread is primarily hematogenous, with potential for bone, lung, brain, liver, bladder, and skin involvement and some metastatic activity resulting in hyperthyroidism

    Medullary Thyroid Cancer

    • Tumor type: Neuroendocrine; originates from parafollicular (C) cells
    • TFTs: Usually normal
    • Feature: Calcitonin production (tumour marker)
    • Occurrence: Sporadic or part of inherited syndrome (80% sporadic, slightly more common in females)
    • Presentation: Single nodule, often with cervical lymphadenopathy
    • Familial: Part of MEN-2
    • Pre-surgery evaluation: Necessary for neuroendocrine tumors with regards to surgical procedures involving neuroendocrine tissues.

    Anaplastic Thyroid Cancer

    • Tumor type: Undifferentiated, from thyroid follicular epithelium
    • Characteristic: Highly aggressive, mortality approaches 100%
    • Symptoms: Local invasion, hoarse voice, difficulty swallowing
    • General: Usually affects older patients; early palliative care critical; surgery usually not indicated in the early stages of treatment.

    Multiple Endocrine Neoplasia (MEN)

    • MEN-1: Autosomal dominant; RET gene mutation; affects parathyroid, pituitary and pancreatic endocrine.
    • MEN-2a: Autosomal dominant; RET gene mutation; affects medullary thyroid cancer, pheochromocytoma, hyperparathyroidism.
    • MEN-2b: Autosomal dominant; RET gene mutation; affects medullary thyroid cancer, pheochromocytoma, ganglioneuromas, marfanoid habitus.

    Thyroid Nodule Evaluation

    • Diagnosis: Combining clinical history, physical examination, blood tests, radiology (ultrasound, US-guided fine-needle aspiration [FNAC], scan), and pathology.
      • Clinical: Hx, examination, labs (thyroid function tests: TSH, T4, T3)
      • Radiology: Ultrasound (U/S); isotope scan; CT or MRI (occasionally)
      • Pathology: Fine-needle aspiration cytology (FNAC)

    Poor Prognostic Factors for Thyroid Cancer

    • Older age
    • Large tumor size
    • Soft tissue invasion
    • Distant metastases

    Thyroid Surgery Indications (Benign):

    • Goiter: Compressing adjacent structures; cosmetic reasons
    • Toxic Goiter: Non-response to medical treatment; pregnancy; refractory hyperthyroidism
    • Thyrotoxicosis: Control is treatment goal (toxic multinodular goiter, toxic adenoma, Graves disease)

    Thyroid Surgery Indications (Malignant):

    • Total Thyroidectomy: High-risk differentiated thyroid cancer (tumor ³ 4 cm or gross extrathyroidal extension); clinically obvious metastatic nodes/ distant spread; medullary thyroid cancer; prior head/neck radiation or family hx of differentiated thyroid cancer;
    • Thyroid Lobectomy: Low-risk differentiated thyroid cancer (<4 cm without gross extra-thyroidal extension or clinical nodes involvement); unifocal cancers < 1 cm (no prior head/neck radiation or family hx of thyroid malignancy)

    Thyroidectomy - Surgical Approach

    • Positioning: Supine with neck extended
    • Incision: Transverse incision
    • Procedure: Identification & protection of vital structures; adequate exposure; dissection and removal of gland, hemostasis, and closure (absorbable sutures).

    Post-Operative Management

    • In-patient stay: Usually 1-2 days
    • Monitoring: Routine observations/analgesia
    • Post-Surgical Complications:
      • Early: Hematoma, nerve injury (laryngeal, recurrent), vocal cord paresis, transient hypoparathyroidism, hypocalcemia, seroma formation, thyroid storm
      • Intermediate: Infection
      • Late: Permanent hypoparathyroidism, Horner's syndrome (rare), recurrence (malignancy)

    Radioactive Iodine (RAI) Therapy in Thyroid Cancer

    • Application: Well-differentiated thyroid cancers (papillary, follicular)

    • Use: Post operative treatment to reduce recurrence risk; treatment of residual or recurrent disease; treatment of hyperthyroidism

    • Goals:

      • Ablation of remnants of functioning thyroid tissue
      • Treatment following surgery for recurrence prevention
      • Treatment when disease is present (residual cancer, recurrent structural or biochemical disease, or metastatic disease)

    • Contraindications: Pregnancy, breastfeeding

    • Complications: Acute gastritis/enteritis, acute sialadenitis, xerostomia, dysgeusia, transient bone marrow suppression (high doses)

    • RAI therapy decision: Multidisciplinary process based on recurrence/persistent disease risk. RAI therapy is not routinely recommended for low-risk unifocal (tumor < 1 cm) or multifocal tumors (< 1 cm) without other high-risk features.

    Additional Notes

    • Abbreviations: TFTs- Thyroid Function Tests, RAI- Radioactive Iodine, FNAC- Fine Needle Aspiration Cytology, TSH- Thyroid Stimulating Hormone, T4- Thyroxine, T3- Triiodothyronine, MEN- Multiple Endocrine Neoplasia.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Thyroid Surgery Year 2 2024-2025 RCSI PDF

    Description

    This quiz covers essential aspects of thyroid surgery for Year 2 Surgery students. Topics include the anatomy of the thyroid gland, indications for lobectomy versus total thyroidectomy, and the role of radioactive iodine in managing thyroid cancer. It also delves into the differential diagnoses for both benign and malignant thyroid nodules.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser