Thyroid MCQs

Papillary Thyroid carcinoma

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Q) A 30-year-old female is diagnosed with papillary thyroid carcinoma (PTC) following a fine-needle aspiration biopsy. Ultrasound shows a 1.8 cm solid nodule in the left thyroid lobe, and the ultrasound reveals no evidence of cervical lymphadenopathy. The patient's medical history is unremarkable, and she has no family history of thyroid cancer. According to the NCCN guidelines, which of the following management strategies is MOST appropriate for this patient?

A. Total thyroidectomy, as the tumor size exceeds 1 cm and there is a risk of contralateral disease.

B. Lobectomy with careful monitoring, as there is no extrathyroidal extension or lymph node involvement, and the tumor size is less than 2 cm.

C. Active surveillance with regular follow-up and ultrasound monitoring, given the tumor size and absence of aggressive features.

D. Lobectomy followed by radioactive iodine ablation to reduce the risk of recurrence.

 

Thyroid storm

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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 idodine

Thyroid MCqs

Ans c

Explanation:
In the management of a thyroid storm, radioactive iodine (RAI) is not used. RAI is a predisposing factor for thyroid storm, not a treatment. The management includes beta blockers, oxygen and hemodynamic support, IV Lugol iodine, PTU (propylthiouracil), and corticosteroids.

Medullary thyroid cancer – Management

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Q) 42 year old Male patient with 1 cm nodule in Right side of Thyroid. Biopsy shows medullary carcinoma. No neck nodes are seen on USG. What is the management

a) Total thyroidectomy

b) Total thyroidectomy with central node dissection

c) Total thyroidectomy with lateral and central neck dissection

d) Right hemithyroidectomy

Thyroid MCQs 

Thyroid Mock test 1 

Thyroid Mock test 2 

Thyroid 3 

Ans b 

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. Given the risk of lymphatic spread with MTC, central node dissection is recommended.

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. While MTC can spread to lateral nodes, the primary recommendation is to start with central node dissection unless there are clinical signs or imaging suggesting lateral node involvement. A more conservative approach is often favored unless there's clear evidence of lateral disease.

d) Right hemithyroidectomy

  • A hemithyroidectomy would only remove half of the thyroid gland and is inadequate for managing MTC. Since MTC can be bilateral and has the potential for multifocality, a total thyroidectomy is the standard of care to ensure complete removal of the cancerous tissue.

Hyperthyroidism in Pregnancy

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Q) Which of the following is true for hyperthyroidism in Pregnancy

A) Surgery done in 2nd trimester

B) Beta blockers are contraindicated

C) All antithyroid drugs are contraindicated

D) Radioactive iodine (RAI) is treatment of choice

Prognosis Carcinoma thyroid

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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.

Papillary carcinoma thyroid

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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

 

 

Medullary carcinoma thyroid

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Q) Medullary carcinoma thyroid, what test is not done (NEET 2019) 

a) Calcitonin

b) Glucagon

c) VMA

d) CEA

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