Thyroid Disease and Surgery

2.15.1 Discuss the differential diagnosis of a thyroid mass. What % of thyroid nodules over 1cm are malignant?

2.15.2 Describe the four major carcinomas of the thyroid gland (incidence, histologic features and prognosis). What are hurthle cells?

2.15.3 In the evaluation of a patient with a thyroid nodule, what should you look for in the H&P? Any risk factors for cancer?

2.15.4 Discuss the role of lab work and imaging tests in the work up of a thyroid nodule.

American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167-214. PMID:19860577

2.15.5 Give us an algorithm for the work up of a thyroid nodule.

Aguilar J, Rodriguez JM, Flores B, Sola J, Bas A, Soria T, Ramirez P, Parrilla P. Value of repeated fine-needle aspiration cytology and cytologic experience on the management of thyroid nodules. Otolaryngol Head Neck Surg. 1998 Jul;119(1):121-4. PMID:9674524

2.15.6 What is the role of fine needle aspiration (FNA) in the preoperative workup of a thyroid nodule over 1cm?

2.15.7 How would you manage a patient with a 8mm thyroid nodule with known papillary thyroid cancer diagnosis on FNA? Are there options?

2.15.8 What are the indications for post-operative radioactive iodine in the treatment of thyroid carcinoma?

2.15.9 Discuss guidelines for follow-up post-total thyroidectomy for cancer (labs, imaging, follow-up, etc)

2.15.10 What is the role of central neck dissection in the management of papillary thyroid carcinoma? What are the risks associated with this procedure when done appropriately/comprehensively?

2.15.11 List prognostic factors (AMES vs. AGES criteria).