nbme 1 - usmleicandoit

[ArchivalUser]

Surgical removal is the treatment of choice for thyroid carcinomas. Neck ultrasound is useful both preoperatively and in follow-up. For differentiated papillary and follicular carcinoma, thyroidectomy with limited removal of cervical lymph nodes is adequate.

Following total or near-total thyroidectomy, patients with differentiated thyroid carcinoma receive an RAI neck and whole-body scan, either while hypothyroid, or after thyrotropin administration. In patients with visible RAI uptake, those with stage II“IV cancer should be treated with adjuvant 131I therapy, when possible.

Ref: CMDT


I still think E) is the right anwser

[ArchivalUser]

Ans is EEEEEEEEEEEE

hyperthyroidism) or too little (hypothyroidism). Although not definitive, this information is helpful because thyroid nodules are more often benign when blood levels of thyroid hormone are abnormal.

Fine-needle aspiration biopsy. This test is the most sensitive for distinguishing between benign and malignant thyroid nodules. During the procedure, your doctor inserts a thin needle ” much smaller than the needles used to draw blood ” in the nodule and removes a sample of cells. The procedure, which is carried out in your doctor's office, takes about 20 minutes and has few risks. Your doctor is likely to take several samples from a single nodule. If you have more than one nodule, your doctor will usually take samples from these as well. Sometimes, especially in the case of complex cysts, your doctor may use ultrasound to help guide the placement of the needle. The samples are then sent to a laboratory and analyzed under a microscope.
Most nodules diagnosed using FNA biopsy are benign. These nodules may grow, but they aren't cancerous and won't spread beyond the thyroid gland. A small percentage of biopsied nodules are malignant. This diagnosis is based on the characteristics of individual cells and patterns in clusters of cells that are different from normal thyroid tissue. In some cases, a pathologist can determine specific types of cancer from an FNA biopsy sample.

Sometimes there may not be enough cells in a sample to accurately determine whether a nodule is benign or malignant. In that case, you're likely to have the test repeated. And in some FNA biopsies, the test results are considered suspicious or indeterminate, which means there's no definitive way to tell from the biopsy sample whether the nodule is cancerous. Repeat biopsies usually aren't helpful in suspicious cases, so the next step is often surgery to remove the nodule for a definitive diagnosis.

Ultrasonography. This imaging technique uses high-frequency sound waves rather than radiation to produce images. It may be used to distinguish cysts from solid nodules and to guide your doctor in performing an FNA biopsy.
Thyroid scan. Sometimes you may have a thyroid scan to help evaluate thyroid nodules. During this test, an isotope of radioactive iodine is injected into the vein on the inside of your elbow. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. Nodules that produce excess thyroid hormone ” called "hot" nodules ” show up on the scan because they take up more of the isotope than normal thyroid tissue does. "Warm" nodules look and function like normal tissue, while "cold" nodules are nonfunctioning and appear as defects or holes in the scan. Hot nodules are almost always benign, but a small percentage of warm or cold nodules are malignant. The disadvantage of a thyroid scan is that it can't distinguish between benign and malignant warm and cold nodules. The length of a thyroid scan varies, depending on how long it takes the isotope to reach your thyroid gland. You may have some neck discomfort because your neck is stretched back during the scan, and you will be exposed to a small amount of radiation.

[ArchivalUser]

I agree

[ArchivalUser]

Hi nida
what is CMDT,can u plz explain
thankyou

[ArchivalUser]

To nickiestep2

Current Medical Diagnosis and Treatment (CMDT)
GL

[ArchivalUser]

guys its a trap...........ofcourse the treatment of thyroid cancer is total or near total thyroidectomy with or with out neck dissection but its NEVER lobectomy.........it asks whats the next best step so I 131 will help reduce size of cancer then thyroidectomy.hope this clears the doubts.

[ArchivalUser]

Thank you sith for point this out, but according to NMS, patient with solitary nodule, can directely go for thyroid lobectomy or isthmusectomy.


Patients with lesions 1 cm or less are divided into two groups: one, patients with previ-
ous head and neck radiation, who should undergo a total thyroidectomy; and two, those
patients who have not had radiation, who can undergo a limited thyroid lobectomy and
isthmusectomy.

Due to the increased incidence of multicentricity in papillary cancer, some physicians recommend a total thyroidectomy for cancers larger than 1.5 cm. Nodal excision ("berry picking"), without the need for a prophylactic neck dissection, may be useful for lymph node metastasis.

[ArchivalUser]

thankyou nida for making me understand! yes now i agree the answer is E thyroid lobectomy

[ArchivalUser]

The discussion helped me a lot, too.
Let's have more discussions in 2007 and crush the step2. Best of luck to our forum members. Happy 2007 !!!