THYROID TUMORS

Tumors are classified on the basis of: Being benign or malignant The presence or absence of thyrotoxicosis The diffuse or irregular quality of glandular enlargement. If the enlargement is sufficient to cause a visible swelling in the neck, the tumor is referred to as GOITER. Grades of goiter:

Barely visible and producing disfigurement. Symmetric and diffuse Nodular Accompanied by hyperthyroidism Toxic or non-toxic

ENDEMIC (IODINE-DEFICIENT) GOITER SIMPLE OR COLLOID GOITER - Most common type of goiter encountered chiefly in geographic regions where the natural supply of iodine is deficient. (e.g., Great Lakes areas of the United States) - May be caused by an intake of large quantities of goitrogenic substance in patients with unusually susceptible glands. These substances include excessive amounts of iodine or lithium, which is used in treating bipolar disorders. - Represents a compensatory hypertrophy of the thyroid gland,

caused by stimulation by the pituitary gland. Its production increases if there is subnormal thyroid activity, as when insufficient iodine is available for production of the thyroid hormone. Such goiters usually cause no symptoms, except for the swelling in the neck. SSKI, a supplementary iodine which is prescribed to suppress the pituitarys thyroid-stimulating activity Ensuring a preoperative euthyroid state through treatment with antithyroid medication and iodide will minimize the risk of postoperative complications. Providing children in iodine-poor regions with iodine compounds can prevent simple or endemic goiter. The introduction of iodized salt has been the single most effective means of preventing goiter in at-risk populations.

NODULAR GOITER
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Some thyroid glands are nodular because of areas of hyperplasia (overgrowth) No symptoms may arise as a result of this condition, but not uncommonly these nodules slowly increase in size, with some descending into the thorax, where they cause local pressure symptoms. Some nodules become malignant Some are associated with a hyperthyroid state

THYROID CANCER
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Much less prevalent than other forms of cancer; however it accounts for 90% of endocrine malignancies According to American Cancer Society, such cases are more occurring to men than the women. Types: Papillary adenocarcinoma 70%- most common, least aggressive, asymptomatic, starts in childhood or early adult life/ more aggressive in adults life, metastasizes along the lymphatics if untreated Follicular adenocarcinoma 15%- appears after 40 yrs. of age, encapsulated, feels elastic or rubbery on palpation, spreads through the blood stream to bone, liver and lung, prognosis is not as favorable as papillary adenocarcinoma Medullary 5%- after 50 yrs. of age, occurs as part of multiple endocrine neoplasia (MEN), hormone producing tumor causing endocrine dysfunction symptoms, metastasizes by lymphatics and bloodstream, moderate survival rate Anaplastic 5%- after 60 yrs. of age, hard, irregular mass that grows quickly and spreads by direct invasion to adjacent tissues, may be painful or tender, survival is usually less than 6 months

Thyroid lymphoma 5%- after 40 yrs. of age, may have history of goiter, hoarseness, dyspnea, pain and pressure, good prognosis External radiation of the head, neck or chest in infancy and childhood increases the risk of thyroid carcinoma. Appears to increase 5 to 40 years after Consequently, people who underwent radiation treatment or were otherwise exposed to radiation as children should consult a physician and request an isotope thyroid scan as part of the evaluation.