I do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.
I do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.
I do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.
When children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.
When children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.
When children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors↗
▶Ep 3 · 4:27
clinicalThyroid conditions and cancers have familial predisposition including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes↗
▶Ep 3 · 6:23
quoteThyroid nodules are less common in children than adults, but when they're detected, they're more likely to be malignant.↗
▶Ep 3 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant↗
▶Ep 3 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 3 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults↗
▶Ep 3 · 8:08
guidelineCurrent ATA recommendations state that hyperfunctioning nodules (hot nodules) do not need to be biopsied if they are going to be resected↗
▶Ep 3 · 8:08
quoteThe current recommendations are that that nodule does not need to be biopsied if it's going to be resected.↗
▶Ep 3 · 9:57
clinicalUltrasound features suspicious for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, and microcalcifications↗
▶Ep 3 · 11:12
guidelineIn adults, lesions less than 1 centimeter are not biopsied, but in pediatric patients size cutoffs cannot be used as in adults; ultrasound characteristics and clinical context determine biopsy indication↗
▶Ep 3 · 11:12
quoteThe criteria for FNA biopsy for the adults is that you don't biopsy a lesion that's less than 1 centimeter. For the pediatric population, we can't use size cutoffs as they do in adults.↗
▶Ep 3 · 15:00
epidemiologicalPapillary thyroid cancer in children shows bilateral disease in up to 30% of patients and multifocal disease in up to 65% of pediatric patients↗
▶Ep 3 · 15:00
guidelineCurrent recommendations for papillary thyroid cancer are total or near-total thyroidectomy due to risk of bilateral disease, multifocal disease, increased recurrence risk with lobectomy alone, and ability to optimize for radioactive iodine therapy↗
▶Ep 3 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease↗
▶Ep 3 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 3 · 18:33
quoteThere's no evidence to do a prophylactic lateral neck dissection.↗
▶Ep 3 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in pediatric thyroid cancer↗
▶Ep 3 · 19:37
clinicalAfter total thyroidectomy, PTH level less than 10-15 in recovery indicates higher risk for hypocalcemia and warrants starting calcium replacement or calcitriol↗
▶Ep 3 · 21:12
guidelineLow-risk papillary thyroid cancer (disease confined to thyroid with no metastatic lymph nodes) requires only postoperative thyroglobulin monitoring with TSH goal of 0.5-1, ultrasound at 6 months then annually for 5 years, and no radioactive iodine↗
▶Ep 3 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastasis) receive radioactive iodine postoperatively↗
▶Ep 3 · 23:05
clinicalFollicular lesions are indeterminate specimens representing about one-third of FNA results, with three subtypes: follicular lesion of undetermined significance, follicular lesion concerning for neoplasm, and suspicious/suggestive of malignancy with follicular component↗
▶Ep 3 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected.↗
▶Ep 3 · 23:50
guidelineMost recent ATA recommendations are that all indeterminate lesions in children be resected due to higher malignancy risk compared to adults↗
▶Ep 3 · 24:07
epidemiologicalFollicular lesions of undetermined significance have 5-15% malignancy risk in adults but approximately 28% in pediatric literature↗
▶Ep 3 · 24:18
epidemiologicalFollicular neoplasms have reported malignancy rate of 15-30% but more recent data suggests 50-60% in pediatric patients↗
▶Ep 3 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma but can identify papillary component↗
▶Ep 3 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 3 · 26:10
guidelineFollicular carcinoma with significant vascular invasion or tumor greater than 4 centimeters requires completion thyroidectomy; minimal vascular invasion with smaller tumor can be monitored↗
▶Ep 3 · 27:01
epidemiologicalAfter lobectomy for benign disease, approximately 30% of patients may develop hypothyroidism at some point, requiring thyroid function monitoring↗
▶Ep 3 · 27:31
guidelineHigh-risk papillary thyroid cancer patients have TSH suppression goal of less than 0.1, while low-risk patients have goal of 0.5-1↗
▶Ep 3 · 28:49
clinicalFor thyroid masses greater than 4 centimeters, the sensitivity and specificity of FNA is decreased, requiring careful follow-up even if benign↗
▶Ep 3 · 29:02
guidelineBenign FNA results should be followed with repeat ultrasound in 6-12 months with repeat biopsy if the mass is enlarging or develops suspicious features↗
▶Ep 3 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of initial FNA↗
▶Ep 3 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 3 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every pediatric patient with a thyroid nodule↗
▶Ep 3 · 33:01
guidelinePatients with medullary thyroid cancer and calcitonin level greater than 500 at presentation require imaging to exclude metastatic disease including CT neck, CT chest, MRI or CT abdomen, and possibly bone scan↗
▶Ep 3 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism↗
▶Ep 3 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and Marfanoid habitus with elongated features and joint laxity↗
▶Ep 3 · 34:11
clinicalMEN 2B patients with RET 918 mutation present with thyroid cancer very early, in infancy, with reported cases as young as 3 months↗
▶Ep 3 · 34:31
guidelineMEN 2B patients with 918 mutation should have thyroidectomy before one year of age↗
▶Ep 3 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 3 · 35:13
epidemiologicalDe novo RET mutations are more likely to be MEN 2B than 2A↗
▶Ep 3 · 35:42
guidelineMEN 2A patients are classified as high-risk or moderate-risk based on specific RET codon mutations, with different timing recommendations for prophylactic thyroidectomy↗
▶Ep 3 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds↗
▶Ep 3 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN 2A surveillance, central neck dissection is recommended at time of thyroidectomy↗
▶Ep 3 · 36:36
clinicalChildren under age 10 have increased risk of complications from thyroidectomy including hypoparathyroidism and nerve injury due to smaller anatomy↗
▶Ep 3 · 36:36
quoteChildren under the age of 10, that is why we don't prophylactically do thyroidectomies on all children at the youngest age.↗
▶Ep 3 · 36:59
guidelineMEN 2A moderate-risk patients have thyroidectomy when serum calcitonin becomes elevated or if parents decline frequent surveillance↗
▶Ep 3 · 37:55
guidelineMEN 2A high-risk patients begin pheochromocytoma screening at age 11; moderate-risk patients begin at age 16↗
▶Ep 3 · 39:03
guidelineCentral lymph node dissection for medullary thyroid cancer is not necessary if prophylactic thyroidectomy is performed before calcitonin levels exceed 40↗
▶Ep 3 · 40:22
guidelineAfter medullary thyroid cancer surgery, if calcitonin levels are greater than 150, imaging is needed to detect metastasis including CT neck, CT chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton↗
▶Ep 3 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors and external beam radiation) has significant side effects and is reserved for progressive disease not treatable with surgery, not used routinely for elevated calcitonin alone↗
▶Ep 3 · 42:29
opinionIn young children with Graves' disease, surgery is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine↗
▶Ep 3 · 43:52
clinicalDiffuse infiltration of the thyroid (rather than discrete nodule) is a characteristic of papillary thyroid cancer that is more common in children and should prompt biopsy especially if suspicious lymph nodes are present↗
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors↗
▶Ep 11 · 4:27
clinicalThyroid conditions and cancers have familial predisposition including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes↗
▶Ep 11 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant↗
▶Ep 11 · 6:23
quoteThyroid nodules are less common in children than adults, but when they're detected, they're more likely to be malignant.↗
▶Ep 11 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults↗
▶Ep 11 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 11 · 8:08
quoteThe current recommendations are that that nodule does not need to be biopsied if it's going to be resected.↗
▶Ep 11 · 8:08
guidelineCurrent ATA recommendations state that hyperfunctioning nodules (hot nodules) do not need to be biopsied if they are going to be resected↗
▶Ep 11 · 9:57
clinicalUltrasound features suspicious for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, and microcalcifications↗
▶Ep 11 · 11:12
quoteThe criteria for FNA biopsy for the adults is that you don't biopsy a lesion that's less than 1 centimeter. For the pediatric population, we can't use size cutoffs as they do in adults.↗
▶Ep 11 · 11:12
guidelineIn adults, lesions less than 1 centimeter are not biopsied, but in pediatric patients size cutoffs cannot be used as in adults; ultrasound characteristics and clinical context determine biopsy indication↗
▶Ep 11 · 15:00
epidemiologicalPapillary thyroid cancer in children shows bilateral disease in up to 30% of patients and multifocal disease in up to 65% of pediatric patients↗
▶Ep 11 · 15:00
guidelineCurrent recommendations for papillary thyroid cancer are total or near-total thyroidectomy due to risk of bilateral disease, multifocal disease, increased recurrence risk with lobectomy alone, and ability to optimize for radioactive iodine therapy↗
▶Ep 11 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 11 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease↗
▶Ep 11 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in pediatric thyroid cancer↗
▶Ep 11 · 18:33
quoteThere's no evidence to do a prophylactic lateral neck dissection.↗
▶Ep 11 · 19:37
clinicalAfter total thyroidectomy, PTH level less than 10-15 in recovery indicates higher risk for hypocalcemia and warrants starting calcium replacement or calcitriol↗
▶Ep 11 · 21:12
guidelineLow-risk papillary thyroid cancer (disease confined to thyroid with no metastatic lymph nodes) requires only postoperative thyroglobulin monitoring with TSH goal of 0.5-1, ultrasound at 6 months then annually for 5 years, and no radioactive iodine↗
▶Ep 11 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastasis) receive radioactive iodine postoperatively↗
▶Ep 11 · 23:05
clinicalFollicular lesions are indeterminate specimens representing about one-third of FNA results, with three subtypes: follicular lesion of undetermined significance, follicular lesion concerning for neoplasm, and suspicious/suggestive of malignancy with follicular component↗
▶Ep 11 · 23:50
guidelineMost recent ATA recommendations are that all indeterminate lesions in children be resected due to higher malignancy risk compared to adults↗
▶Ep 11 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected.↗
▶Ep 11 · 24:07
epidemiologicalFollicular lesions of undetermined significance have 5-15% malignancy risk in adults but approximately 28% in pediatric literature↗
▶Ep 11 · 24:18
epidemiologicalFollicular neoplasms have reported malignancy rate of 15-30% but more recent data suggests 50-60% in pediatric patients↗
▶Ep 11 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma but can identify papillary component↗
▶Ep 11 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 11 · 26:10
guidelineFollicular carcinoma with significant vascular invasion or tumor greater than 4 centimeters requires completion thyroidectomy; minimal vascular invasion with smaller tumor can be monitored↗
▶Ep 11 · 27:01
epidemiologicalAfter lobectomy for benign disease, approximately 30% of patients may develop hypothyroidism at some point, requiring thyroid function monitoring↗
▶Ep 11 · 27:31
guidelineHigh-risk papillary thyroid cancer patients have TSH suppression goal of less than 0.1, while low-risk patients have goal of 0.5-1↗
▶Ep 11 · 28:49
clinicalFor thyroid masses greater than 4 centimeters, the sensitivity and specificity of FNA is decreased, requiring careful follow-up even if benign↗
▶Ep 11 · 29:02
guidelineBenign FNA results should be followed with repeat ultrasound in 6-12 months with repeat biopsy if the mass is enlarging or develops suspicious features↗
▶Ep 11 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of initial FNA↗
▶Ep 11 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 11 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every pediatric patient with a thyroid nodule↗
▶Ep 11 · 33:01
guidelinePatients with medullary thyroid cancer and calcitonin level greater than 500 at presentation require imaging to exclude metastatic disease including CT neck, CT chest, MRI or CT abdomen, and possibly bone scan↗
▶Ep 11 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism↗
▶Ep 11 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and Marfanoid habitus with elongated features and joint laxity↗
▶Ep 11 · 34:11
clinicalMEN 2B patients with RET 918 mutation present with thyroid cancer very early, in infancy, with reported cases as young as 3 months↗
▶Ep 11 · 34:31
guidelineMEN 2B patients with 918 mutation should have thyroidectomy before one year of age↗
▶Ep 11 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 11 · 35:13
epidemiologicalDe novo RET mutations are more likely to be MEN 2B than 2A↗
▶Ep 11 · 35:42
guidelineMEN 2A patients are classified as high-risk or moderate-risk based on specific RET codon mutations, with different timing recommendations for prophylactic thyroidectomy↗
▶Ep 11 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds↗
▶Ep 11 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN 2A surveillance, central neck dissection is recommended at time of thyroidectomy↗
▶Ep 11 · 36:36
clinicalChildren under age 10 have increased risk of complications from thyroidectomy including hypoparathyroidism and nerve injury due to smaller anatomy↗
▶Ep 11 · 36:36
quoteChildren under the age of 10, that is why we don't prophylactically do thyroidectomies on all children at the youngest age.↗
▶Ep 11 · 36:59
guidelineMEN 2A moderate-risk patients have thyroidectomy when serum calcitonin becomes elevated or if parents decline frequent surveillance↗
▶Ep 11 · 37:55
guidelineMEN 2A high-risk patients begin pheochromocytoma screening at age 11; moderate-risk patients begin at age 16↗
▶Ep 11 · 39:03
guidelineCentral lymph node dissection for medullary thyroid cancer is not necessary if prophylactic thyroidectomy is performed before calcitonin levels exceed 40↗
▶Ep 11 · 40:22
guidelineAfter medullary thyroid cancer surgery, if calcitonin levels are greater than 150, imaging is needed to detect metastasis including CT neck, CT chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton↗
▶Ep 11 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors and external beam radiation) has significant side effects and is reserved for progressive disease not treatable with surgery, not used routinely for elevated calcitonin alone↗
▶Ep 11 · 42:29
opinionIn young children with Graves' disease, surgery is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine↗
▶Ep 11 · 43:52
clinicalDiffuse infiltration of the thyroid (rather than discrete nodule) is a characteristic of papillary thyroid cancer that is more common in children and should prompt biopsy especially if suspicious lymph nodes are present↗
clinicalRisk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors↗
▶Ep 8 · 4:27
clinicalThyroid conditions and cancers have familial predisposition including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes↗
▶Ep 8 · 6:23
epidemiologicalThyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant↗
▶Ep 8 · 6:23
quoteThyroid nodules are less common in children than adults, but when they're detected, they're more likely to be malignant.↗
▶Ep 8 · 6:31
quoteWhen children actually do present with a thyroid cancer, they're more likely to have an extension outside of the thyroid. They're more likely to have regional lymph node involvement. And distant metastasis.↗
▶Ep 8 · 6:31
clinicalWhen children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults↗
▶Ep 8 · 8:08
guidelineCurrent ATA recommendations state that hyperfunctioning nodules (hot nodules) do not need to be biopsied if they are going to be resected↗
▶Ep 8 · 8:08
quoteThe current recommendations are that that nodule does not need to be biopsied if it's going to be resected.↗
▶Ep 8 · 9:57
clinicalUltrasound features suspicious for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, and microcalcifications↗
▶Ep 8 · 11:12
quoteThe criteria for FNA biopsy for the adults is that you don't biopsy a lesion that's less than 1 centimeter. For the pediatric population, we can't use size cutoffs as they do in adults.↗
▶Ep 8 · 11:12
guidelineIn adults, lesions less than 1 centimeter are not biopsied, but in pediatric patients size cutoffs cannot be used as in adults; ultrasound characteristics and clinical context determine biopsy indication↗
▶Ep 8 · 15:00
epidemiologicalPapillary thyroid cancer in children shows bilateral disease in up to 30% of patients and multifocal disease in up to 65% of pediatric patients↗
▶Ep 8 · 15:00
guidelineCurrent recommendations for papillary thyroid cancer are total or near-total thyroidectomy due to risk of bilateral disease, multifocal disease, increased recurrence risk with lobectomy alone, and ability to optimize for radioactive iodine therapy↗
▶Ep 8 · 17:07
opinionNerve monitoring is used routinely during thyroidectomy; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease↗
▶Ep 8 · 17:07
quoteI do routinely use a nerve monitor in my practice, knowing that it will not decrease my risk of nerve injury, but I do find it helpful in identifying the nerve, especially in patients with bulky cervical disease.↗
▶Ep 8 · 18:33
guidelineThere is no evidence to support prophylactic lateral neck dissection in pediatric thyroid cancer↗
▶Ep 8 · 18:33
quoteThere's no evidence to do a prophylactic lateral neck dissection.↗
▶Ep 8 · 19:37
clinicalAfter total thyroidectomy, PTH level less than 10-15 in recovery indicates higher risk for hypocalcemia and warrants starting calcium replacement or calcitriol↗
▶Ep 8 · 21:12
guidelineLow-risk papillary thyroid cancer (disease confined to thyroid with no metastatic lymph nodes) requires only postoperative thyroglobulin monitoring with TSH goal of 0.5-1, ultrasound at 6 months then annually for 5 years, and no radioactive iodine↗
▶Ep 8 · 21:48
guidelineIntermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastasis) receive radioactive iodine postoperatively↗
▶Ep 8 · 23:05
clinicalFollicular lesions are indeterminate specimens representing about one-third of FNA results, with three subtypes: follicular lesion of undetermined significance, follicular lesion concerning for neoplasm, and suspicious/suggestive of malignancy with follicular component↗
▶Ep 8 · 23:50
quoteThe most recent recommendations from the ATA are that all of these indeterminate lesions be resected.↗
▶Ep 8 · 23:50
guidelineMost recent ATA recommendations are that all indeterminate lesions in children be resected due to higher malignancy risk compared to adults↗
▶Ep 8 · 24:07
epidemiologicalFollicular lesions of undetermined significance have 5-15% malignancy risk in adults but approximately 28% in pediatric literature↗
▶Ep 8 · 24:18
epidemiologicalFollicular neoplasms have reported malignancy rate of 15-30% but more recent data suggests 50-60% in pediatric patients↗
▶Ep 8 · 25:04
clinicalFrozen section cannot distinguish follicular adenoma from follicular carcinoma but can identify papillary component↗
▶Ep 8 · 25:36
quoteA frozen section will not be able to tell you a follicular adenoma from a follicular carcinoma.↗
▶Ep 8 · 26:10
guidelineFollicular carcinoma with significant vascular invasion or tumor greater than 4 centimeters requires completion thyroidectomy; minimal vascular invasion with smaller tumor can be monitored↗
▶Ep 8 · 27:01
epidemiologicalAfter lobectomy for benign disease, approximately 30% of patients may develop hypothyroidism at some point, requiring thyroid function monitoring↗
▶Ep 8 · 27:31
guidelineHigh-risk papillary thyroid cancer patients have TSH suppression goal of less than 0.1, while low-risk patients have goal of 0.5-1↗
▶Ep 8 · 28:49
clinicalFor thyroid masses greater than 4 centimeters, the sensitivity and specificity of FNA is decreased, requiring careful follow-up even if benign↗
▶Ep 8 · 29:02
guidelineBenign FNA results should be followed with repeat ultrasound in 6-12 months with repeat biopsy if the mass is enlarging or develops suspicious features↗
▶Ep 8 · 29:49
clinicalInadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of initial FNA↗
▶Ep 8 · 31:34
guidelineSporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every pediatric patient with a thyroid nodule↗
▶Ep 8 · 31:34
quoteSporadic medullary thyroid cancer is unusual in children, so the current recommendations are not to do routine calcitonin monitoring in every patient that presents with a thyroid nodule.↗
▶Ep 8 · 33:01
guidelinePatients with medullary thyroid cancer and calcitonin level greater than 500 at presentation require imaging to exclude metastatic disease including CT neck, CT chest, MRI or CT abdomen, and possibly bone scan↗
▶Ep 8 · 33:36
clinicalMEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism↗
▶Ep 8 · 33:47
clinicalMEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and Marfanoid habitus with elongated features and joint laxity↗
▶Ep 8 · 34:11
clinicalMEN 2B patients with RET 918 mutation present with thyroid cancer very early, in infancy, with reported cases as young as 3 months↗
▶Ep 8 · 34:31
guidelineMEN 2B patients with 918 mutation should have thyroidectomy before one year of age↗
▶Ep 8 · 34:39
quoteThere are reported cases of having medullary thyroid cancer as young as 3 months in the MEN2B group.↗
▶Ep 8 · 35:13
epidemiologicalDe novo RET mutations are more likely to be MEN 2B than 2A↗
▶Ep 8 · 35:42
guidelineMEN 2A patients are classified as high-risk or moderate-risk based on specific RET codon mutations, with different timing recommendations for prophylactic thyroidectomy↗
▶Ep 8 · 36:03
guidelineMEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds↗
▶Ep 8 · 36:27
guidelineIf calcitonin levels exceed 40 in MEN 2A surveillance, central neck dissection is recommended at time of thyroidectomy↗
▶Ep 8 · 36:36
quoteChildren under the age of 10, that is why we don't prophylactically do thyroidectomies on all children at the youngest age.↗
▶Ep 8 · 36:36
clinicalChildren under age 10 have increased risk of complications from thyroidectomy including hypoparathyroidism and nerve injury due to smaller anatomy↗
▶Ep 8 · 36:59
guidelineMEN 2A moderate-risk patients have thyroidectomy when serum calcitonin becomes elevated or if parents decline frequent surveillance↗
▶Ep 8 · 37:55
guidelineMEN 2A high-risk patients begin pheochromocytoma screening at age 11; moderate-risk patients begin at age 16↗
▶Ep 8 · 39:03
guidelineCentral lymph node dissection for medullary thyroid cancer is not necessary if prophylactic thyroidectomy is performed before calcitonin levels exceed 40↗
▶Ep 8 · 40:22
guidelineAfter medullary thyroid cancer surgery, if calcitonin levels are greater than 150, imaging is needed to detect metastasis including CT neck, CT chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton↗
▶Ep 8 · 41:38
guidelineSystemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors and external beam radiation) has significant side effects and is reserved for progressive disease not treatable with surgery, not used routinely for elevated calcitonin alone↗
▶Ep 8 · 42:29
opinionIn young children with Graves' disease, surgery is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine↗
▶Ep 8 · 43:52
clinicalDiffuse infiltration of the thyroid (rather than discrete nodule) is a characteristic of papillary thyroid cancer that is more common in children and should prompt biopsy especially if suspicious lymph nodes are present↗
