Thyroid Physiology

Classifications

• Thyroid adenoma
• Thyroid Cancer

Presentation

• Symptoms

• ‣

• “Mass Effect”

  • Goitre
  • Dysphagia
  • Hoarse voice/Dysphonia
  • Stridor (inspiration)

• Risk Factors for Carcinoma

  • Male
  • Hx Radiation Therapy - Head & Neck
  • Living around sites of nuclear accident
    • Give iodine → saturate thyroid with normal iodine so no radioactive iodine is absorbed
  • FMHx of thyroid cancer (1st degree relative)
  • Large, rapidly growing mass w/ hoarseness and lymphadenopathy
  • MENS 2 (Type 2A)
  • Uncertain:
    • high iodine intake
    • T2DM (insulin resistance)

Investigation

3 Key tests: TSH (< 5), Thyroid US , Thyroid FNA

• New Mass → TSH (< 5): Assess Functionality
• Thyroid US : Determine if FNA is needed
• Thyroid FNA: Screen for Malignancy → Bethesda Grade (1-6)
• Flow Chart
• Monitoring Recurrence of thyroid cancer

Treatment

Treatment

Clinical Pearl