Q) The sensitivity and specificity of sestamibi for parathyroid localization are reported to be 79% and 90%, respectively. Which of the following best describes a potential source of false positives in sestamibi imaging?
A) Parathyroid adenomas in patients with hyperparathyroidism
B) Thyroid nodules with high oxyphilic content, such as Hürthle cell nodules
Q) A 60-year-old woman is found to have a 3.2 cm pancreatic cystic lesion on MRI. EUS shows internal echogenic material within the cyst cavity. To accurately determine whether this represents mural nodules rather than intraluminal debris, which of the following is the most definitive diagnostic approach?
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Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks.
She presented in emergency with high grade fever and hypotension (Thyroid Storm).
What is not a part of further management?
a) Oxygen
b) Beta blockers
c) Radio active Iodine
d) Lugol's iodine
Correct Answer:c) Radio active Iodine
Explanation:
In the management of a thyroid storm, radioactive iodine (RAI) is not used. In fact, RAI can precipitate a thyroid storm and is contraindicated during acute crises.
Medullary thyroid carcinoma is associated with a risk of nodal involvement, even if neck nodes are not visible on ultrasound. A total thyroidectomy is recommended to remove the affected thyroid tissue, and central neck dissection is indicated to address potential lymphatic spread.
Total thyroidectomy: While a total thyroidectomy is necessary for medullary thyroid carcinoma (MTC) to remove the entire gland, it does not include the assessment and potential removal of central lymph nodes, which can harbor metastases.
c) Total thyroidectomy with lateral and central neck dissection: This option is more extensive than typically required for a 1 cm medullary carcinoma without evidence of lymph node involvement. Start with central node dissection unless there's clear lateral disease.
d) Right hemithyroidectomy: Inadequate for managing MTC. Since MTC can be bilateral and multifocal, a total thyroidectomy is the standard of care.
Q) Not an important prognostic factor in Carcinoma thyroid (JIPMER) ? A. Age B. Completeness of resection C. Multicentricity D. Extra thyroid extension
Ans c
In thyroid carcinoma, important prognostic factors include age (younger patients tend to have a better prognosis), completeness of resection (as complete removal of the tumor affects outcomes), and extra-thyroid extension (invasion beyond the thyroid worsens prognosis). However, multicentricity (the presence of multiple tumor foci within the thyroid) is generally not considered a major prognostic factor.
Most of the papillary carcinoma are multicentric any way
As per AGES And AMES criteria.
HIgh risk - Male. Age more than 40 years, Size more than 4 cm, Capsular or extra thyroid extension, Regional or distant metastasis and poor differentiation
Low Risk - Well differentiated less than 2 cm. Age benefit is extended to 50 yrs in women
IN younger patients (<45 years old), the presence of lymph node metastases had no effect on the excellent overall survival, but the presence of lymph node metastases increased the risk of death by 46% in patients older than 45
The presence of lymph node metastasis in patients with contained intrathyroidal primary papillary carcinoma also does not affect long-term survival.
If there is gross or microscopic extension of a primary PTC through the thyroid capsule, a poor prognosis and possibly a higher rate of lymph node metastasis may be anticipated.
Q) 40 yr old lady 2X 2 Solitarty thyroid nodule left lobe. FNAC shows classic type of papillary carcinoma . Usg no neck nodes. Management? ( Questions on Surgical Onco - thyroid)
A. Total thyroidectomy B. Total thyroidectomy with Radio active Iodine C. Total thyroidectomy with central compartment neck dissection D. Hemithyroidectomy + follow up
