General
Differential
Workup
Therapy and follow up
Random Trivia (maybe medical)
100
What is the percentage prevalence of thyroid nodules found in autopsy?
The prevalence approaches 50% showing that thyroid nodules are very common.
100
Name two diagnoses in the differential for multiple nodules.
Hashimoto Thyroiditis and Multinodular goiter (other option is cancer)
100
What is the main objective of workup of thyroid nodule?
Differentiating carcinomas from benign causes.
100
In patients with non toxic solitary nodules, what may shrink the nodule and prevent growth?
Low dose suppressive therapy with levothyroxine. This is controversial and may end up increasing risk of osteoporosis in postmenopausal women.
100
How much saliva does the average person produce daily?
1 quart
200
Of those patients with thyroid nodules, which subgroups have highest risk for carcinoma?
The rate of carcinoma is twice as high in men and those older than 60 or younger than 30.
200
What percentage of solitary nodules are cancerous?
10 to 20% of solitary nodules are cancerous.
200
What is the initial test for evaluation of euthyroid patients with thyroid nodule?
Fine needed aspiration biopsy. This has replaced radionuclide scanning and ultrasound as first line evaluation because it is more specific. Sensitivity is similar among all three tests.
200
Therapy for small cysts of nontoxic multinodular goiter?
Aspiration of tissue to reduce the appearance, increase comfort and rule out malignancy (1% incidence).
200
How many fat cells does the average person have?
Between 40 and 50 billion!
300
What percentage of nodules that have been biopsied with fine needle aspiration prove to be benign
70%
300
Name the type of nodule that compose the majority of benign nodules. Hint-They have a fibrous capsule. For bonus points- What kind is not encapsulated and found in multinodular goiter?
Follicular. Bonus: Colloid or adenomatous
300
What is the main indication for thyroid ultrasound?
Ultrasound is good at localizing lesions and has unique ability to distinguish cystic versus solid nodules. However it is poor at determining malignancy risk because cystic is not synonymous with benign.
300
When should surgical removal of benign solitary nodule in euthyroid patient be considered?
If nodule continues to enlarge after 1 yr observation and failure to respond to suppressive therapy.
300
Person comes in with back pain. You find tissue texture change at T5. The transverse process is more prominent on R while neutral and gets worse in extension. What is the diagnosis? Bonus: What visceral area do you consider with lesion at T5?
The patient has T5 FRrSr. Flexion /extension (fryette 2, non neutral mechanics) happen usually as single lesions. You name for what the segment likes to do. Consider upper GI (stomach,pancreas,liver,duodenum) for lesions in T5-9 especially recurrent ones.
400
In a patient with nodules, when should they be instructed to call for follow up (what signs are worrisome and should prompt pt to call?)
Change in size, development of lymphadenopathy, pain, dysphagia, or hoarseness.
400
Describe the type of nodule that could lead to thyrotoxicosis.
Follicular adenoma- they function autonomously, suppressing TSH, and appear as "hot" on thyroid scan.
400
Describe the most cost effective testing sequence for workup of a single nodule in euthyroid patient.
Start with fine needle aspiration- if cytology is malignant then proceed to surgery. If cytology is benign, observe for one year with follow up ultrasound. If cytology suspicious then radionuclide scan for uptake is indicated.
400
Who is at risk for overt or subclinical thyrotoxicosis?
Those patients with toxic nodules or autonomously functioning solitary adenomas, especially those >3cm, with upper limit of normal serum triiodothyronine, and unresponsive to thyroxine suppression.
400
What chapman's point is located at the umbilicus?
Urinary bladder
500
Name 2 indications for referral to specialist (for thyroid nodules, as described by Goroll)
Solitary nodule in euthyroid patient, a "worrisome" nodule in patient with multinodular gland, patient with toxic or >3cm adenoma, those with goiter unresponsive to thyroid hormone therapy or causing obstruction.
500
What is the most common type of thyroid carcinoma, and is carcinoma found generally in solitary or multiple nodules?
Most common are papillary and mixed papillary-follicular carcinomas. (70% of all thyroid malignancies). Mostly found in solitary nodules.
500
What percentage of "cold" nodules as identified on radionuclide scanning are malignant?
5-15% of cold nodules turn out to be malignant. A result of "warm"nodule does not eliminate malignant potential. A "hot" nodule has very low malignant potential and is considered to be autonomously functioning and may respond to suppressive therapy.
500
Name the two options for ablative therapy of toxic nodules and which demographic they are best suited for.
Surgery and radioiodine. Surgery is indicated in young patients to reduce risk of cancer to adjacent tissue from radioiodine therapy. Radioiodine is less invasive and simpler for elderly population.
500
What did the Federal building next to Dr. Grossman's office in Battle Creek used to be?
Battle Creek Sanatarium- Founded by the Kellogg brothers it was developed as a health retreat. Many rich and famous people willingly stayed at the sanitarium to find wellness and listen to lectures and begin healthy lifestyles.
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