!"#$%&'()*%!+'!+!),-)./+)./0#,%*)$('1*) #6@<E>K;K%?

@C%K>A5><;7@%7D%<E657;C%E7537@>
'@?<736%7D%<E>%<E657;C%98?@C
!"#$%&'($)"%*+%,'&*")"-$.%-/.%012#%

$345678796:%

15;3;<;=>%?8;3>@<?56%<5?A<B%$@C7C>53?8%;@%75;9;@%

08775%7D%<E>%FE?56@G%HD75?3>@%A>AI3%7D%<7@9I>J%
?@C%C>KA>@CK%<7%?@<>5;75%@>AL%

0788;AI8?5% A>88K% D573% 8?<>5?8% ?@8?9>B% 2% A>88K% D573%

<E
<E>% I8<;3745?AE;?8% ?5AE% 7D% <E>% M % FE?56@9>?8%
F7IAE%

27@9>@;<?8%?@73?8;>K% 1NO#P")"RO:% *E>%;7C;C>%A6A8>+%P@9>K<>C%;7C;C>%;K%<5?FF>C%;@%<E>%<E657;C%

cannot be synthesized w/o
98?@C.% 7G;C;Y>C.% ?@C% 47I@C% <7% <657K;@>% <7% D753%
'*NO&$"P#P#% 9 iodine
#OQ*N$#P#%"0%*NO&"P/%N"&-"Q$% ;7C7<657K;@>K% ;@% <E6579874I8;@+% 27IF8;@9% 7D% ;7C7<657K68%
5>K;CI>K%D753K%*M%?@C%*Z+%N7537@>%K>A5><>C%46%<E>%98?@C%
1O&'-P/')%)",$% 9 #$2&$*P"Q%"0%*NO&"P/%N"&-"Q$% ;K%<5?@KF75<>C%;@%<E>%K>5I3+%#73>%*M%;K%C>;7C;@?<>C%<7%*Z+%
secondary function only: parathyroid *E>%E7537@>%>G>5<K%;<K%3><?478;A%>DD>A<%7@%<E>%A>88%?@C%;K%
)'*$&')%',$&&'Q*%*NO&"P/% 9 #$2&$*P"Q%"0%2')2P*"QPQ%
primary I8<;3?<>86%C>;7C;@?<>C+%*E>%;7C;C>%;K%5>IK>C%75%>GA5><>C%46%
<E>% L;C@>6K+% '% K>A7@C% A6A8>% 97>K% 7@% ;@K;C>% <E>% <E657;C%
)PQRS')%*NO&"P/%R)'Q/% *E657;C%E7537@>%K6@<E>K;K%?@C%K>A5><;7@% 98?@C% [;<E% C>;7C;@?<;7@% 7D% ;7C7<657K;@>K% 9>@>5?<;@9%
;7C;C>.% [E;AE% ;K% 5>IK>C% [;<E7I<% 8>?=;@9% <E>% <E657;C+%
*NO&"R)"##')%/S2*%2O#*% P"/PQ$%-$*',")P#-% #6@<E>K;K%?@C%K>A5><;7@%7D%<E657;C%E7537@>%%
/>KA>@<%7D%<E>%<E657;C%98?@C% 1&"/S2*P"Q.% #*"&'R$% 'Q/% #$2&$*P"Q% "0%
*NO&"P/%N"&-"Q$% #6@<E>K;K%?@C%K>A5><;7@%7D%<E657;C%E7537@>
Stored in colloid
$00$2*#%"Q%$Q/T"&R'Q%'Q/%&$RS)'*P"Q% T3 & T4 + Thyrogolbulin
Inside Follicles
THYROID
P7C;@>%3><?478;K3:% GLAND +
TSH

P7C;@>%3?;@86%D573%>G79>@7IK%K7I5A>% Half-life:
T3 = 3 days Secretion of
T4 = 7 days T3 and T4
P@9>K<>C% ;7C;@>% ?4K754>C% 5?F;C86% D753% RP*% Peripheral activity:
T3 > T4
HU%E7I5J%
metabolism
P7C;@>% C;K<5;4I<;7@B% 3?;@86% <7% L;C@>6% ?@C% Free Iodide Peripheral target
<E657;C%HVWXJ% organs

% TSH also stimulates

% hyperplasia, secretion and
T4 is more albumin bound
%

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! /!!

!
&>9I8?<;7@%7D%*N%K6@<E>K;K\K>A5><;7@%D573%C5I9K% $=?8I?<;7@%7D%F?<;>@<K%[;<E%*E657;C%98?@C%C;K75C>5% *E657;C%0I@A<;7@%*>K<K%

*N&$$%-'PQ%2'*$R"&P$#% ->?KI5>3>@<%7D%A;5AI8?<;@9%*#N%%

NO1"0SQ2*P"Q% #>5I3%*#N%%
Euthyroid: normal function
NO1$&0SQ2*P"Q% #>5I3%*Z\05>>%*Z%%
negative / positive
feedback $Q)'&R-$Q*#\R"P*$&% #>5I3%*M\05>>%*M%%

/P00S#$%$Q)'&R-$Q*% 05>>%<E657G;@>%;@C>G%%

Q"/S)'&%$Q)'&R-$Q*% *E657G;@>%4;@C;@9%4874I8;@%%

]]]% &?C;7?A<;=>%;7C;@>%IF<?L>%%

28;@;A?8%>=?8I?<;7@% ->?KI5>K%7D%'I<7;33I@;<6%% grave & hashimoto

%
NP#*"&O%'Q/%1NO#P2')%$^'-PQ'*P"Q%% '@<;T<E6579874I8;@%?@<;47C6%%
#AE>3?%7D%<E>%E73>7K<?<;A%5>9I8?<;7@%7D%<E657;C%DI@A<;7@+%
#>A5><;7@% 7D% *#N% ;K% 5>9I8?<>C% 46% ?% @>9?<;=>% D>>C4?AL% 28;@;A?8%3?@;D>K<?<;7@K:%% '@<;T3;A57K73?8%?@<;47C6%%
3>AE?@;K3%?A<;@9%C;5>A<86%7@%<E>%F;<I;<?56%?@C%;K%@753?886%
;@=>5K>86% 5>8?<>C% <7% <E>% A7@A>@<5?<;7@% 7D% I@47I@C% NO1$&0SQ2*P"Q%% )7@9%?A<;@9%K<;3I8?<;@9%'4%H)'*#J%%
E7537@>% ;@% <E>% 4877C+% &>8>?K>% 7D% *#N% ;K% ;@CIA>C% 46% *&N%
_>;9E<% 87KK.% ;55;<?4;8;<6.% E>?<% ;@<78>5?@A>.% *E657;C%K<;3I8?<;@9%P33I@79874I8;@%%
K>A5><;7@.% [E;AE% K><K% <E>% 8>=>8% 7D% <E>% F;<I;<?56% D>>C4?AL%
3>AE?@;K3+% 0?A<75K% 5>9I8?<;@9% K>A5><;7@% 7D% *&N% ?5>% <E;@@;@9%7D%E?;5.%F?8F;<?<;7@K.%<?AE6A?5C;?%%
*E657;C%98?@C%?@C%1;<I;<?56%98?@C%5>KF7@K>%
I@A>5<?;@%4I<%3?6%;@A8IC>%<E>%D5>>%E7537@>%;@%<E>%4877C%
?@C%K<;3I8;%D573%E;9E>5%A>@<>5K+%'I<75>9I8?<756%A7@<578%7D% NO1"0SQ2*P"Q%%
*Z%KIFF5>KK;7@%<>K<%
<E657;C%DI@A<;7@%?8K7%;K%KE7[@%
_>;9E<% 9?;@.% 8><E?596.% A7?5K>% E?;5.% A78C%
;@<78>5?@A>.% <E;AL% KL;@.% K87[>C% 3IKA8>% 5>D8>G.% *E657<E57F;@% 5>8>?K>;@9% E7537@>% H*&NJ%
-><E;3?Y78>% H<?F?Y78>J% 75% 2?54;3?Y78>% K<;3I8?<;7@%<>K<%
H@>73>5A?Y78>J:%;@E;4;<%*N%K6@<E>K;K%46%487AL;@9% A7@K<;F?<;7@.%K87[%3>@<?<;7@%%
<E>% 7G;C?<;7@% 7D% P"/P/$% ;@<7% P"/PQ$% ?@C% <E>% *E657;C% K<;3I8?<;@9% E7537@>% H*#NJ% K<;3I8?<;7@%
R"P*$&%%
A7IF8;@9%7D%-P*%?@C%/P*% <>K<%
'@<>5;75%@>AL%3?KK%<E?<%37=>K%7@%C>98I<;<;7@%;K%
1*S% HF57F68<E;7I5?A;8J:% ?A<K% <E>% K?3>% [?6% ?K% 'KK>KK3>@<%7D%'@?<736%
<E657;C% 98?@C% ;@% 75;9;@% I@8>KK% F57=>@% 7<E>5[;K>B% goiter, cystic
3><E;3?Y78>%4I<%3?6%?K87%;@E;4;<%<E>%F>5;FE>?58%
>@8?59>C%<E657;C%98?@C%%
A7@=>5K;7@%7D%*M%;@<7%*Z% PK7<7F>%KA?@%
1E6K;A?8%$G?3;@?<;7@:%%
% S8<5?K7@;A%KA?@%
'AAI5?<>% C>KA5;F<;7@% 7D% <E>% <E657;C% 98?@C% ?@C%
% N;K<7879;A\A6<7879;A%?KK>KK3>@<%
3?KK%%
% 275>%@>>C8>%4;7FK6% establish anaplastic ca.
'FF5>A;?<>% F5>K>@A>% 75% ?4K>@A>% 7D% ?KK7A;?<>C%
% A>5=;A?8%863FE?C>@7F?<E6%%
0;@>% @>>C8>% ?KF;5?<;7@% 4;7FK6\A6<78796%
% H0Q',\0Q'2J%
%

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! .!!

!
NO1$&*NO&"P/P#-% R>@>5?886% <>53>C% *E657;C% &>A>F<75% N6F>5<E657;C;K3%%
'@<;47C;>K%H*&'4J%%
28;@;A?8% K6@C573>% 7D% >GA>KK% <E657;C% E7537@>% ;@% /P'RQ"#P#%%
<E>%A;5AI8?<;7@%% _E?<%;@;<;?<>K%D753?<;7@%7D%<E>%'4%K<;88%I@A8>?5%%
N;K<756%?@C%1E6K;A?8%$G?3;@?<;7@%%
*[7%C73;@?@<%<6F>K%75%A?IK>K:%% R>@><;A%D?A<75K%;@=78=>C%%
*E657;C%0I@A<;7@%<>K<K%%
'% *E657;C% 98?@C% ;K% C;DDIK>86% >@8?59>CB%
E6F>5=?KAI8?5%% &?C;7?A<;=>%;7C;@>%<E657;C%KA?@%%
*7G;A%3I8<;@7CI8?5%75%K78;<?56%@7CI8?5%97;<>5%
W% -?6% 5>KF7@C% [>88% <7% 5?C;7?A<;=>% ;7C;@>% -'Q'R$-$Q*%%
<5>?<3>@<%%
2?@% 4>% 1&P-'&O% H;@A5>?K>C% *E657;C% E7537@>% -$/P2')%-'Q'R$-$Q*%%
;@C>F>@C>@<% 7D% *#NJ% 75% #$2"Q/'&O% H;@A5>?K>C% -I8<;@7CI8?5%*7G'W%
;@%E7537@>%CI>%<7%;@A5>?K>C%*#NJ%% '@<;T<E657;C%C5I9K%H3><E;3?Y78>.%1*SJ%%
"@>% 75% 375>% <E657;C% @7CI8>K% <5?FF;@9% ?@C%
2?IK>K%7D%N6F>5<E657;C;K3% 759?@;D6;@9% 375>% ;7C;@>% ?@C% ;@A5>?K>% K>A5><;7@% ,><?T487AL>5K%HF57F5?@7878J%%
7D% E7537@>% ;@C>F>@C>@<% 7D% *#N% A7@<578B% in prepration to
?I<7@737IK86%DI@A<;7@;@9%@7CI8>\K%% P7C;@>%% surgery; dec.
vascularity
27337@%;@%?5>?K%[;<E%>@C>3;A%97;<>5K%% #S&R$&O%% only if w/ goiter

-;8C>5%[;<E%@7%>G<5?<E657;C?8%3?@;D>K<?<;7@K%% #I4<7<?8%<E657;C>A<736B%)74>A<736%%

2?@% 4>% K>A7@C?56% <7% <E>% !7CT,?K>C7[% )>?=>%M%%a%93K%<E657;C%<;KKI>%%

FE>@73>@7@%%
&'/P"'2*P($%P"/PQ$%*&$'*-$Q*%%
/>37@K<5?<>% ;@A5>?K>C% IF<?L>% 75% 5?C;7?A<;=>%
UZU /;DDIK>%b%c%%V%32;%%
;7C;@>%P %87A?8;Y>C%<7%<E>%@7CI8>\K%%
Q7CI8?5%b%U`%%Ua%32;%%
% #78;<?56% <7G;A% ?C>@73?% % 4>8;>=>C% <7% 4>% ?%
D788;AI8?5%@>7F8?K3%% *E657;C%#<753%
'%
1775% 5>KF7@K>% <7% 5?C;7?A<;=>% ;7C;@>% <5>?<3>@<B% &?5>% 4I<% 8;D>T<E5>?<>@;@9% A73F8;A?<;7@% 7D%
*&P'/% "0% R7;<>5.% *E657<7G;A7K;K.% $G7FE<E?837K%
KI59>56%;K%<E>%AE7;A>%7D%3?@?9>3>@<%% E6F>5<E657;C;K3%%
;K>?K>J%%

27337@%;@%[73>@B%`WTMW%6>?5K%7D%?9>%% N6F>5<E657;C;K3
P@CIA>C% 46% <E657;C?8% 75% @7@T<E657;C?8% KI59>56B%
A?@% 4>% ;@CIA>C% 46% ;@D>A<;7@% 75% 7<E>5% D753K% 7D%
'KK7A;?<>C% >G<5?<E657;C?8% 3?@;D>K<?<;7@K:% K<5>KK%H>9+%)?475%d%C>8;=>56.%FI837@?56%;@D>A<;7@.%
>G7FE<E?837K.% F5><;4;?8% 36G>C>3?.% ?D<>5%&'P%<5>?<3>@<J%%
C>537F?<E6.%?A57F?<E6.%?@C%=;<;8;97%% DIFFUSE GLAND ENLARGMENT

#;9@K%?@C%K63F<73K%7D%K>=>5>%<E657<7G;A7K;K%%
'I<7;33I@>%C;K>?K>%%
N6F>5F65>G;?.% K>=>5>% <?AE6A?5C;?.%
)'*#%H87@9T?A<;@9%<E657;C%K<;3I8?<;@9%'4J%% PRETIBIAL MYXEDEMA ;55;<?4;8;<6.% =73;<;@9.% C;?55E>?.% ?@C%
F57G;3?8% 3IKA8>% [>?L@>KKB% A?IK>% 7D%
*5$9(623+7+$/023$7+<
*E657;CTK<;3I8?<;@9%P9%H*#PJ%75%'4%H*#'4J%% C>?<E%CI>%<7%E;9E%A?5C;?A%7I<FI<%%
%
!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! *!!

!
 -?@?9>3>@<:%% supportive 2?IK>K%7D%N6F7<E675;C;K3% 'AI<>%KIFFI5?<;=>%<E657;C;<;K%%

15>=>@<;7@%;K%<E>%4>K<%3?@?9>3>@<%% ! &?5>.% F5>C73;@?@<86% ;@% ?C78>KA>@A>%

?@C%AE;8C5>@%%
P33>C;?<>% A7@<578% 7D% <?AE6A?5C;?.%
3>AE?@;A?8% A778;@9.% 7G69>@% ?@C% =78I3>% ! SFF>5% 5>KF;5?<756% <5?A<% ;@D>A<;7@B% 3?6%
5>KIKA;<?<;7@%% E?=>%KIFFI5?<;7@%%

#<>57;CK%% ! '@<;4;7<;AKB%KI59>56%5?5>86%@>>C>C%%

P@<5?=>@7IK%4><?T487AL>5K%HF57F5?@7878J%% *E657;C%Q7CI8>%%C;?9@7K;K%?@C%3?@?9>3>@<%

'@<;T<E657;C%C5I9K%?@C%P7C;@>%K78I<;7@%% &>8?<;=>86% A7337@% 3>C;A?8% F5748>3B% =?5;>C%

<5>?<3>@<%7F<;7@K%
1>5;<7@>?8%C;?86K;K%;@%>G<5>3>%A?K>K%%
15;3?56% AE?88>@9>% ;@% 3?@?9>3>@<% ;K% <7%
NO1"*NO&"P/P#-% C;K<;@9I;KE%4>@;9@%D573%3?8;9@?@<%@7CI8>%

#6@C573>% 7D% C>D;A;>@<% A;5AI8?<;@9% 8>=>8K% 7D% % #>8>A<;7@%7D%F?<;>@<%D75%7F>5?<;7@%IKI?886%A?@@7<%

<E657;C%E7537@>%% 4>%4?K>C%7@%K;@98>%<>K<%
*E657;C;<;K%%
25><;@;K3% ;@% @>7@?<>K% % @>I57879;A?8% #E7I8C%E?=>%A734;@>C%?KK>KK3>@<%7D%?88%A8;@;A?8.%
;3F?;53>@<%?@C%3>@<?8%5><?5C?<;7@%% 'I<7;33I@>% 863FE7A6<;A% <E657;C;<;K% 8?475?<756%?@C%5?C;7879;A%;@D753?<;7@%
,%
surgery if w/ goiter,
28;@;A?8%3?@;D>K<?<;7@K:%% "59?@;Y>C% ?FF57?AE% <7% 47<E% 4>@;9@% ?@C%
autoimmune ! 'I<7;33I@>B% 37K<% A7337@% A?IK>% 7D%
3?8;9@?@<% @7CI8>% IKI?886% 9;=>K% <E>% F57F>5%
-6G>C>3?%HK>=>5>%D753J%% E67F<E657;C;K3%%
<5>?<3>@<%7F<;7@%
,5?C6A?5C;?%d%A?5C;73>9?86%% ! *E657;C% E7537@>% 5>F8?A>3>@<% >GA>F<%
R$Q$&')%2"Q#P/$&'*P"Q#:%
;D%[;<E%8?59>%97;<>5%%
)?475?<756:%% *E657;C%@7CI8>%375>%A7337@%;@%D>3?8>K%HZTM:UJ%
^Y%
/>A5>?K>C%*Z%?@C%*MB%$8>=?<>C%*#N%% MWTaWX%;@A;C>@A>%7D%7AAI8<%3I8<;@7CI8?5%<E657;C%
! R5?@I873?<7IK%75%9;?@<%A>88%<E657;C;<;K%%
C;K>?K>B% UWT`WX% ;@A;C>@A>% 7D% 7AAI8<% K78;<?56%
-?@?9>3>@<:%% @7CI8>% ;@% ?K63F<73?<;A% F?<;>@<K% H46% ?I<7FK6%
! 'AI<>%;@D8?33?<;7@B%=;5?8%><;78796%%
?@C%S*eJ%
*E657G;@>%5>F8?A>3>@<%%
! *E657;C%F?;@%%
MTaX% 7D% @7CI8>% ;@% 9>@>5?8% F7FI8?<;7@% ;K%
%
ZK%% 3?8;9@?@<%
%
! -?5L>C.%C>@K>C%;@=?K;=>%D;457K;K%7D%<E>% #78;<?56% @7CI8>% b% 3?8;9@?@<% ;@% a% % `WX% 7D%
% 98?@C%% F?<;>@<K%

% ! -?6% 5>K>348>% ?@?F8?K<;A% A?5A;@73?B% `WTZWX%7D%<E7K>%>GF7K>C%<7%>G<>5@?8%5?C;?<;7@%;@%

K3?88>5%97;<>5%% <E>% @>AL% [;88% E?=>% F?8F?48>% <E657;C%
% ?4@753?8;<;>K% ?@C% `WTZWa% 7D% <E>3% 3?6% A7@<?;@%
% <E657;C%A?5A;@73?%
%
!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! 0!!

!
 *E657;C% A?@A>5% ;K% <E>% 37K<% A7337@86% 7F>5?<>C% #S&RP2')%-'Q'R$-$Q*%D75%,>@;9@%<E657;C%@7CI8>% 0;@>%@>>C8>%?KF;5?<;7@%A6<78796%%
>@C7A5;@>%98?@C%3?8;9@?@A6%
'<% 8>?K<% ?% *E657;C% )",$2*"-O% 7D% <E>% ?DD>A<>C% #;@98>%37K<%IK>DI8%<>K<%H5>A733>@C>CJ%%
*E657;C%@7CI8>:%/P00$&$Q*P')%/P'RQ"#P#% K;C>%[;<E%;K<E3IK>A<736%%
N;9E% K>@K;<;=;<6% >GA>F<% D75% D788;AI8?5%
27887;C%?C>@73?\A6K<% #I4<7<?8% <E657;C>A<736% \% #>8>A<;=>% A?5A;@73?%%
<E657;C>A<736%D75%3I8<;@7CI8?5%C;K>?K>%%
*E657;C;<;K% )7[%KF>A;D;A;<6%H%`WX%D?8K>T@>9?<;=>J%%
15>K>5=?<;7@%7D%<E>%5>AI55>@<%8?56@9>?8%@>5=>%%
'W% PQ/P2'*P"Q#% 0"&% *N$% 1$&0"&-'Q2$% "0% *NO&"P/%
057Y>@% 4;7FK6% D75% KIKF>A<>C% A?K>K% ?@C% E;9E% 5;KL% #S&R$&O%
N6F>5DI@A<;7@;@9%?I<7@737IK%@7CI8>% F?<;>@<K%;@<5?T7F>5?<;=>86%%
*E657;C% >@8?59>3>@<% HR7;<>5J% A?IK;@9%
0788;AI8?5%?C>@73?% *#N%#S11&$##P"Q%D75%,>@;9@%<E657;C%@7CI8>% A73F5>KK;7@%K63F<73K%HC6KFE?9;?.%C6KF@>?J%

*>5?<73?% 075%K3?88%4>@;9@%@7CI8>K%HA8;@;A?8%?@C%0Q'2J%% 2>5<?;@%<6F>K%7D%N6F>5<E657;C;K3%

-><?K<?<;A%8>K;7@\%@7CI8>% SKI?886%8>KK%<E?@%`%A3%% *E657;C%Q7CI8>\K%75%*E657;C%2?@A>5%

15;3?56%<E657;C%A?5A;@73?% )T<E657G;@>%9;=>@%?<%<7G;A%C7K>%<7%KIFF5>KK%*#N%% 15>K>@A>%7D%KI4K<>5@?8%97;<>5%

/P'RQ"#P#% 28;@;A?8% ?@C% ;3?9;@9% >=?8I?<;7@% <7% ?KK>KK% 27K3><;A%;@C;A?<;7@%

5>KF7@K>%%
2)PQP2')%C;?9@7K;K:% *NO&"P/%2'Q2$&%
)',"&'*"&O%/P'RQ"#P#:%%
N;K<756%?@C%FE6K;A?8%>G?3;@?<;7@% *E>% 37K<% A7337@% >@C7A5;@>% 3?8;9@?@A6% <E?<%
Q7% >DD>A<;=>% K>5I3% <I375% 3?5L>5B% 37K<% [;<E% 5>iI;5>K%KI59>56%
28;@;A?8%AE?5?A<>5;K<;AK%KI99>K<;=>%7D%3?8;9@?@A6:% K78;<?56%@7CI8>%?5>%AE>3;A?886%>I<E657;C%%
P@A8IC>C% ;@% <E>% <7F% UW% K;<>K% 7D% 3?8;9@?@A6% D75%
-?8>% &?C;7?A<;=>%<E657;C%KA?@%% 47<E%K>G>K%;@%<E>%1E;8;FF;@>K%

'9>%fUa.%g%hW%6>?5K% *>AE@>A;I3% HVV3*AJB% &?C;7?A<;=>% P7C;@>% R>@>5?886%K87[T957[;@9%?@C%;@C78>@<%3?8;9@?@A6%

HUZU%75%U`ZJ%%
N;K<756%7D%5?C;?<;7@%>GF7KI5>% 'R$%%A7@K;C>5>C%<E>%37K<%;3F75<?@<%F579@7K<;A%
278C.%[?53%75%E7<%@7CI8>K%% D?A<75%
#78;<?56%@7CI8>%
-?8;9@?@A6%;@%E7<%@7CI8>K%f%ZX%% 2>5<?;@%<6F>K%?5>%?8K7%?995>KK;=>%3?8;9@?@A6%?@C%
N?5C%@7CI8>% F7<>@<;?886%D?<?8%C;K>?K>%
-?8;9@?@A6%;@%A78C%@7CI8>K%%`W%<7%ZWX%%
0?3;86%E;K<756%7D%<E657;C%A?@A>5% -'!"&%NP#*")"RP2%*O1$#%
-7K<%A78C%@7CI8>K%?5>%K<;88%4>@;9@%%
N;K<756%7D%<E657;C;<;K% 1'1P))'&O%*NO&"P/%2'Q2$&%
S8<5?K7I@C%%
N7?5K>@>KKB%=7A?8%A75C%K63F<73K% -7K<%A7337@%HcWXJB%[>88TC;DD>5>@<;?<>C%
#78;C% 75% A6K<;A% @7CI8>B% A?@% C><>A<% U% 33%
2>5=;A?8%?C>@7F?<E6% @7CI8>%% #87[T957[;@9B%863FE?<;A%KF5>?C%
% % R77C%F579@7K;K%

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! -!!

!
 0"))P2S)'&%*NO&"P/%2'Q2$&% 1?88;?<=>%KI59>56%

@C
_>88TC;DD>5>@<;?<>CB% ` % 37K<% A7337@% #*'RPQR%0"&%*NO&"P/%2'Q2$&%H*Q-%28?KK;D;A?<;7@J% *NO&"P/%2'Q2$&
HUWXJ% #S--'&O%"0%#*'RPQR
*%H<I375J% FOR WELL-DIFFERENTIATED THYROID CANCER*
-75>% ?995>KK;=>B% =?KAI8?5% ;@=?K;7@% ?@C% Less than 45 years More than 45 years old
KF5>?C% *U% % <I375% f% 75% b% <7% U+W% A3.% 8;3;<>C% <7% <E657;C% Stage old
98?@C%
-P^$/%1'1P))'&OT0"))P2S)'&%*NO&"P/%2'Q2$&% Stage I Any T, Any N, M0 T1, N0, M0
*`%%<I375%;K%U+W%%M+W%A3%8;3;<>C%<7%<E>%<E657;C% Stage II Any T, Any N, M1 T2 T3, N0, M0
,>E?=>K% ?@C% 3?@?9>C% ?K% F?F;88?56% 98?@C% Stage III T4, N0, M0
A?5A;@73?% Any T, N1, M0
*Z% % <I375% ;K% g% M+W% A3% 8;3;<>C% <7% <E>% <E657;C% Stage IV Any T, Any N, M1
* DIFFERENT GROUP STAGING FOR UNDIFFERENTIATED
NS&*N)$T2$))%*S-"&% 98?@C%
THYROID CANCER

aX%;@A;C>@A>B%;@<>53>C;?<>%C;DD>5>@<;?<;7@% *M%%?@6%K;Y>%[;<E%>G<>@K;7@%4>67@C%<E>%A?FKI8>% < 45 Mo - always stage 1

,>E?=>K%8;L>%D788;AI8?5%A?5A;@73?%4I<%KF5>?C%
46%863FE?<;AK%
)O-1N"-'%HaXJ%
SKI?886% ;@% D>3?8>KB% E;K<756% 7D% F5>=;7IK%
% '-$#%#A75;@9%K6K<>3%
#I59>56%D75%A73F5>KK;=>%K63F<73K%
2E>37%?@C%5?C;?<;7@%K>@K;<;=>%
7D%<E>%<E657;C%98?@C% > 45 M1 - always stage 4
1&"RQ"#*P2%0'2*"&#%\%&P#j%'##$##-$Q*%
Q%H@7C?8%K<?<IKJ%
'R$#%#A75;@9%K6K<>3%
QW%%@7%5>9;7@?8%863FE%@7C>K%
T 'R$.%R&'/$.%$^*$Q*.%#Pe$%
QU%%[;<E%5>9;7@?8%@7C?8%3><?K<?K;K%
QU?%%;FK;8?<>5?8%@7C?8%3><?K<?K;K%
T 'R$.%-$*'#*'#P#.%$^*$Q*.%#Pe$%
QU4% % 3><?K<?K;K% <7% 4;8?<>5?8.% 3;C8;@>% 75%
A7@<5?8?<>5?8%A>5=;A?8%75%3>C;?K<;@?8%)Q% -'2P#%KA?8>%

-$/S))'&O%*NO&"P/%2'Q2$&% -%H3><?K<?K;KJ% T -$*'#*'#P#.% 'R$.% 2"-1)$*$Q$##% "0%

PQP*P')% #S&RP2')% &$#$2*P"Q.% #Pe$% "0%
'995>KK;=>B%A?8A;<7@;@%F57CIA;@9%<I375% -W%%@7%C;K<?@<%3><?K<?K;K% *S-"#%

VWX% KF75?C;AB% UWX% F?5<% 7D% <E>% -$Q% PP% -U%%[;<E%C;K<?@<%3><?K<?K;K% /Q'%0)"_%2O*"-$*&O%
K6@C573>%
-'Q'R$-$Q*% < 1cm, no compression, just observe
UZU
/7>K%@7<%IF<?L>%P %
#S&R$&O%
1775%F579@7K;KB%I@C;DD>5>@<;?<>C%A?5A;@73?% cancer, unilobar, differentiated
at least < 3 cm, < 45 y.o )",$2*"-O%k%P#*N-S#$2*"-O%
'Q'1)'#*P2%*NO&"P/%2'Q2$&%
*"*')%*NO&"P/$2*"-O%
_75K<%F579@7K;KB%=>56%?995>KK;=>% can be resected well differentiated,
to prevent airway obstruction bilobar, > 45 y.o, M1, PQ/P2'*$/%Q$2j%/P##$2*P"Q%
ZWX% C>=>87F>C% D573% [>88TC;DD>5>@<;?<>C% but still dies after 2-3 months
A?@A>5%HC>9>@>5?<;7@J% %

2E>37%?@C%5?C;?<;7@%<5>?<3>@<% %

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! 1!!

!
 '/!S('Q*%*&$'*-$Q*% transverse incisions #S&RP2')%/P#$'#$#%"0%*N$%1'&'*NO&"P/%R)'Q/#%
*>AE@;iI>%7D%<E657;C>A<736

1"#*"1$&'P($% &'/P"'2*P($% P"/PQ$% '@?<736%\%$345678796%?@C%1E6K;78796%

*&$'*-$Q*%
T 07I5% F?5?<E657;C% 98?@CK% % `% KIF>5;75% ?@C% `%
$^*$&Q')%,$'-%&'/P'*P"Q% ;@D>5;75%98?@CK%%

2N$-"*N$&'1O%H>3>59;@9J% T 08?<.%7=7;C%?@C%5>CT457[@%<7%6>887[%%

2"-1)P2'*P"Q#%"0%*NO&"P/%#S&R$&O%% % T Z%G%Z%G%Z%33%%

T (7A?8%A75C%F?5?86K;K%% T ZW%%aW%39%%

T N6F7F?5?<E657;C;K3%HE6F7A?8A>3;?J%% T P@D>5;75%<E657;C%?5<>56%%3?;@%4877C%KIFF86%%

T N6F7<E657;C;K3%% T M<E% % a<E% [>>LK% 7D% D><?8% 8;D>% % FE?56@9>?8%

F7IAE>K%C>=>87F>C%%
T _7I@C%E>3?<73?%\%48>>C;@9%%
% T M<E% F7IAE% k% 8?<>5?8% <E657;C% ?@8?9>% b% KIF>5;75%
1"#*"1$&'*P($%2'&$%% 98?@C%%

T $8>=?<>%E>?C%% T Z5C%F7IAE%k%<E63IK%b%;@D>5;75%98?@C%

T -7@;<75%D75%F7KK;48>%;33>C;?<>%A73F8;A?<;7@:%%
15;3?56%0I@A<;7@%;K%<E>%$Q/"2&PQ$%&$RS)'*P"Q%"0%2')2PS-%
,8>>C;@9%% 'Q/%1N"#1N'*$%-$*',")P#-+

E6F7A?8A>3;?%% % Hormonal Regulation of Calcium and Phosphate metabolism

Parathyroid Hormone Vitamin D Calcitonin

T ->?KI5>K%D75%5>F8?A>3>@<%;@%A?K>K%7D:%% Gastrointestinal tract No direct effect Stimulates calcium and No direct effect
phosphate
absorption

N6F7A?8A>3;?%%
Skeleton Stimulates calcium and Stimulates calcium and Inhibits calcium and
phosphate resorption phosphate phosphate resorption
E6F7<E657;C;K3%% transport

T 'ClI=?@<%<5>?<3>@<%;@%A?@A>5%A?K>K%% Kidneys Stimulates calcium

resorption
No direct effect Inhibits calcium and
phosphate resorption
Inhibits phosphate
resorption

T ';5[?6%3?@?9>3>@<%% %
0>>C4?AL% 877FK% ;@=78=>C% ;@% <E>% 5>9I8?<;7@% 7D% K>5I3%
T 07887[TIF%5>9;3>@%%
A?8A;I3%?@C%FE7KFE75IK%H1*N%%F?5?<E657;C%E7537@>B%2*T
A?8A;<7@;@J

% %

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! 2!!

!
15;3?56%E6F>5F?5?<E6K7;C;K3% &?C;A?8% @>AL% C;KK>A<;7@% D75% 5>AI55>@<% C;K>?K>+% ! Q7% 5>8?<;7@KE;F% 7D% 1*N% 75% A?8A;I3%
&>AI5% 87A?886% ZWXB% C;K<?@<% 3><?K<?K;K% <7% 8I@9% 8>=>8K%<7%<E>%K>=>5;<6%7D%K63F<73K%
P@?FF57F5;?<>86% ;@A5>?K>C% ?37I@<K% 7D% 8;=>5%?@C%47@>%;@%ZWX+%
F?5?<E657;C%E7537@>%H1*NJ%5>8?<;=>%<7%<E>%K>5I3% #I59>56%;3F57=>K%?88%K63F<73K%>GA>F<%?@G;><6+%
A?8A;I3%8>=>8% 28;@;A?8%F5>K>@<?<;7@%%F5;3?56%E6F>5F?5?<E657;C;K3%
1E6K;A?8%>G?3;@?<;7@%%F5;3?56%E6F>5F?5?<E657;C;K3%
"AAI5K%;@%U:UWWW%F7FI8?<;7@% cWX%?5>%?K63F<73?<;A%%
SKI?886%@7<%E>8FDI8%;@%C;?9@7K;K+%
P@A5>?K>C% C><>A<;7@% CI>% <7% ;@A5>?K>% IK>% 7D% #<7@>K%%
K>5I3%A?8A;I3%C><>53;@?<;7@% PD% ?% 3?KK% ;K% F?8F?48>.% KIKF>A<% <E657;C% F?<E78796%
! Q>FE578;<E;?K;K% 75% @>FE57A?8A;@7K;K% 75%F?5?<E657;C%A?5A;@73?%
*E5>>%E;K<7879;A%F?<<>5@:% H@>=>5%47<EJ+%%
)?475?<756%>G?3%%F5;3?56%E6F>5F?5?<E657;C;K3%
#PQR)$%'/$Q"-'% ! UWT`WX%7D%F?<;>@<%%
N6F>5A?8A>3;?.% E6F7FE7KFE?<>3;?.% ?@C%
NO1$&1)'#P'% ! SKI?886% A?8A;I3% FE7KFE?<>+% 2?8A;I3% E6F>5A?8A;I5;?% ?5>% <E>% A8?KK;A% E?883?5LK% 7D%
7G?8?<>%8>KK%A7337@+%% E6F>5F?5?<E657;C;K3%%
1'&'*NO&"P/%2'&2PQ"-'%
,7@>K%% 1*N% 8>=>8K% ?5>% >8>=?<>C% 5>8?<;=>% <7% <E>% K>5I3%
*E5>>% E;K<7879;A% F?<<>5@K% ?5>% K>>@:%% ;7@;Y>C%A?8A;I3%8>=>8%H@753?8%75%IFF>5%@753?8J%%
HF5;3?56%E6F>5F?5<E657;C;K3J%% ! ,7@>% F?;@.% ?5<E5?89;?K.% ?@C% 3IKAI8?5%
?AE>K+%% #>5I3% FE7KFE75IK% [;88% 4>% 87[% ;@% F5;3?56%
#;@98>%?C>@73?%% E6F>5F?5?<E657;C;K3.% E;9E% ;@% K>A7@C?56%
! `WX%7D%K63F<73?<;A%F?<;>@<K+%% E6F>5F?5?<E657;C;K3+%%
VWX%7D%A?K>K%%
! 275<;A?8% 5>K75F<;7@% [;<E% 3>CI88?56% 2E875;C>% [;88% 4>% E;9E% K>A7@C?56% <7% 5>@?8% N2"Z.%
'% 5;3% 7D% @753?8% F?5?<E657;C% <;KKI>% ?57I@C% <E>% 47@>% KF?5;@9% K>A7@C?56% <7% ;@A5>?K>C% [?K<;@9%HC;5>A<%>DD>A<%7D%1*NJ%%
?C>@73?% C;K<;@9I;KE>K% ?C>@73?% D573% <I5@7=>5+%%
E6F>5F8?K;?%%
2E875;C>%<7%FE7KFE75IK%5?<;7%7D%%gZZ%;K%C;?9@7K<;A%
! "K<>;<;K%D;457K?%A6K<;A?%;K%<E>%A7@C;<;7@%    W 
N6F>5F8?K;?%%      F?5?<E657;C%E7537@>%?KK?6%%
    W 
UWX%7D%A?K>K+%% D5?A<I5>K+%% -?8;9@?@A6% [;<E% 75% [;<E7I<% 47@>% 3><?K<?K;K% ;K%
Q7% 5;3% 7D% @753?8% F?5?<E657;C% <;KKI>% ?@C% 8?AL% 7D% <E>% A?IK>% 7D% gaWX% 7D% E6F>5A?8A>3;?%
R57?@K%% HE>3?<7879;A.% 8I@9.% F?@A5>?K.% 47@>.% 7=?56.%
K<573?8%D?<K%%
45>?K<.%?@C%F57K<?<>J+%
! 1>F<;A%I8A>5%C;K>?K>%?@C%F?@A5>?<;<;K%%
'88%M%98?@CK%?5>%;@=78=>C+%%
"<E>5%A?IK>K%7D%E6F>5A?8A>3;?%;@A8IC>:%
! `WX%7D%K63F<73?<;A%F?<;>@<K%%
*E>% E6F>5F?5?<E657;C;K3% 7D% -$Q% K6@C573>K% ;K%
CI>%<7%E6F>5F8?K;?+%% $@C7A5;@>% C;K75C>5K% T% E6F>5<E657;C;K3.% ?C5>@?8%
1K6AE;A%7=>5<7@>K%% ;@KIDD;A;>@A6.%FE>7AE5737A6<73?%%
1?5?<E657;C%A?5A;@73?%T%fUX%7D%A?K>K+%% ! 0?<;9I>.% C>F5>KK;7@.% ?@G;><6.%
(;<?3;@%/%<7G;A;<6%%
;55;<?4;8;<6.% 8?AL% 7D% A7@A>@<5?<;7@.% ?@C%
$GA>F<;7@?886%E;9E%A?8A;I3%75%F?8F?48>%@>AL%3?KK% K8>>F%C;K<I54?@A>K+%%
KE7I8C%5?;K>%KIKF;A;7@+%% )63FE73?K%[;<E%>A<7F;A%(;<?3;@%/Z%F57CIA<;7@%%
! MWX%7D%K63F<73?<;A%F?<;>@<K+%%
$GA;K;7@%[;<E%<E657;C%874>A<736%;K%;@C;A?<>C+%%

!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! 3!!

!
 R5?@I873?<7IK% C;K>?K>% % K?5A7;C7K;K.% -?@?9>3>@<%%F5;3?56%E6F>5F?5?<E657;C;K3% 075%F?5?<E657;C%A?5A;@73?%%
<I4>5AI87K;K.% E;K<7F8?K37K;K.%
27AA;C;7;C736A7K;K.%8>F57K6+%% #I59>56% ;K% <5>?<3>@<% D75% <E>% E6F>5A?8A>3;?% 7D% ! _;C>% >GA;K;7@% ;@A8IC;@9% ;@=78=>C%
E6F>5<E657;C;K3.% 4I<% 7@86% ?D<>5% E6C5?<;7@% [;<E% K<5IA<I5>K%;K%;@C;A?<>C+%%
/5I9K% % <E;?Y;C>K.% 8;<E;I3.% 3;8L% ?8L?8;% K6@C573>+% ?C>iI?<>%I5;@>%7I<FI<%;K%>K<?48;KE>C+%%
P3374;8;Y?<;7@% P@;<;?8% >GF875?<;7@% ;K% KIAA>KKDI8% ;@% VWTVaX% 7D%
#I59;A?8%;@C;A?<;7@K%% A?K>K%[;<E7I<%F5>T7F%87A?8;Y?<;7@%K<IC;>K+%%
&?C;7879;A%$G?3;@?<;7@K:%
! 1?5?<E657;C%A?5A;@73?%% $A<7F;A% 87A?<;7@K:% *E63;A% % KI4K<>5@?8% % `WXB%
#I4F>5;7K<>?8% 5>K75F<;7@% ;@% <E>% A8?KK;A% 17K<>5;75% @>AL% % aTUWXB% P@<5?<E657;C% % aXB%
C;K<5;4I<;7@% 7@% <E>% 5?C;?8% ?KF>A<% 7D% <E>% `@C% ?@C% ! 'K63F<73?<;A%F?<;>@<K%[;<E:%% 2?57<;C%KE>?<E%%UXB% '@<>5;75%3>C;?K<;@I3% %UT
Z5C%FE?8?@9>?8%<ID<K.%?@C%C;K<?8%A8?=;A8>K+%% `X+%%
1>5K;K<>@<% A?8A;I3% >8>=?<;7@%
#78;<?56%47@>%A6K<K%H,57[@%<I375KJ%% UTU+h%39\C8%?47=>%@753?8%% PD% ;@;<;?8% >GF875?<;7@% D?;8K% % 87A?8;Y?<;7@% K<IC;>K%
?5>%;@C;A?<>C+%
P@<5?=>@7IK% F6>8795?3% HP(1J% 3?6% KE7[% 2?8A;I5;?%gMWW%39\C?6%%
I578;<E;?K;K%75%@>FE57A?8A;@7K;K+% )7A?8;Y?<;7@%<>AE@;iI>K%
/>A5>?K>C% 47@>% C>@K;<6% g% `%
->C;A?8%<5>?<3>@<%7D%E6F>5A?8A>3;A%A5;K;K+% K<?@C?5C% C>=;?<;7@% F7;@<K% S8<5?K7I@C%%nWX%?AAI5?A6%D75%98?@CK%?K%K3?88%?K%
D573%@753?8%D75%?9>.%K>G%?@C% Z33+%_;88%@7<%C><>A<%3>C;?K<;@?8%<I375K+%
#63F<73K% ;@A8IC>% ?@75>G;?.% @?IK>?.% =73;<;@9.% 5?A>+%%
F786I5;?.% F786C;FK;?.% ?4C73;@?8% F?;@.% 8><E?596.% 2*% KA?@% \% -&P% % [;88% C><>A<% 3>C;?K<;@?8% <I375K%
47@>%F?;@.%?@C%3IKAI8?5%[>?L@>KK+%% 25>?<;@;@>% A8>?5?@A>% g`%A3+%
C>A5>?K>% 46% ZWX% 4>87[%
PD% I@<5>?<>C% 3?6% F5795>KK% <7% C>E6C5?<;7@.% @753?8%D75%?9>.%K>G.%?@C%5?A>%% *E?88;I3T<>AE@><;I3% KI4<5?A<;7@% KA?@% % nWX%
78;9I5;?.% ?AI<>% <I4I8?5% @>A57K;K% ?@C% C>8;5;I3% ?AAI5?A6%
[;<E;@%E7I5K+%% ! #63F<73?<;A%F?<;>@<K%%
'5<>5;795?FE6%%aWX%?AAI5?A6%
&?F;C% 5>E6C5?<;7@% [;<E% @753?8% K?8;@>% <7% 5>K<75>% ! S578;<E;?K;K%75%@>FE57A?8A;@7K;K%%
I5;@>%7I<FI<+%% #>8>A<;=>% =>@7IK% K?3F8;@9% D75% 1*N% T% cWX%
! 1>F<;A%I8A>5%C;K>?K>%% ?AAI5?A6%
075A>C% C;I5>K;K% [;<E% 0I57K>3;C>% C5;F% HUWT`W%
! 1?@A5>?<;<;K%% 17K<T7F>5?<;=>%A?5>+%%
39\E5J+%%
! -IKAI87KL>8><?8%K63F<73K%%
#<>57;CK%% ';5[?6%3?@?9>3>@<%%
#I59;A?8%7F<;7@K%%F5;3?56%E6F>5F?5?<E657;C;K3%
$<;C57@?<>% /;K7C;I3% c+a% 39\L9% P(% C?;86% D75% Z% N6F7A?8A>3;?% ;K% A7337@% ?@C% 7AAI5K% ?837K<%
C?6K% D7887[>C% 46% aT`W% 39\L9% 1"% C?;86% ;@E;4;<K% ;33>C;?<>86+%%
_;<E%K;@98>%?C>@73?.%5>K>A<;7@%;K%AI5?<;=>+%%
47@>% 3><?478;K3% ;@% E6F>5A?8A>3;?% 7D%
3?8;9@?@A6+% *E;K% KE7I8C% @7<% 4>% IK>C% ;@% 5>@?8% -7@;<75%K>5I3%A?8A;I3%%
075%E6F>5F8?K;?.%%
D?;8I5>%F?<;>@<K+%%
#63F<73K% % ?@G;><6.% E6F>5=>@<;8?<;7@.%
! Z%m%98?@C%5>K>A<;7@%%
-;<E5?36A;@%3?6%4>%IK>C%?K%?%8?K<%5>K75<+%PD%@7<%   d   
IK>C% F57F>586.% A?@% 8>?C% <7% ?F8?K<;A% ?@>3;?% H`a% ! MT98?@C% 5>K>A<;7@% [;<E% m% 98?@C% A;5AI375?8%F?5>K<E>K;?K+%%
3;A5795?3\L9%7=>5%M%E7I5K%P(1,J+%% 5>;3F8?@<>C% ;@% <E>% D75>?53% 75%
K<>5@7A8>;C73?K<7;C% 3IKA8>% ;K% #73>% ?C=7A?<>% <5>?<;@9% 7@86% K63F<73?<;A%
/;?86K;K% A?@% 4>% IK>C% <7% 87[>5% K>5I3% A?8A;I3% ;@C;A?<>C+%% E6F7A?8A>3;?+%%
>3>59>@<86+%
!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! 4!!

!
 *5>?<%E6F7A?8A>3;?%[;<E%75?8%A?8A;I3%A?547@?<>% *$&*P'&O%NO1$&1'&'*NO&"P/P#-%
U% 9% 1"% ihE.% 75% P(% A?8A;I3% 98IA7@?<>% D75% K>=>5>%
E6F7A?8A>3;?%Hf%c+WJ+%% 1>5K;K<>@<% E6F>5F?5?<E657;C;K3% ?@C%
E6F>5A?8A>3;?% D7887[;@9% KIAA>KKDI8% 5>@?8%
(;<?3;@% /% KIFF8>3>@<?<;7@% 3?6% 4>% @>A>KK?56% <5?@KF8?@<%75%5>K78I<;7@%7D%I@C>586;@9%C;K75C>5%
D75%5>D5?A<756%E6F7A?8A>3;?%%
SF% <7% ZWX% 7D% F?<;>@<K% [E7% E?=>% F5>T<5?@KF8?@<%
_?<AE%7I<%D75%48>>C;@9%?@C%;@D>A<;7@% E6F>5F?5?<E657;C;K3%
1?<E7FE6K;78796%;K%;55>=>5K;48>%
#$2"Q/'&O%NO1$&1'&'*NO&"P/P#-%
1?5?<E657;C% 98?@C% E6F>5F8?K;?% [;<E% ?I<7@737IK%
N6F>5F?5?<E657;C;K3% K>A7@C?56% <7% 3?8DI@A<;7@% 1*N%F57CIA<;7@+%
7D%?@7<E>5%759?@%K6K<>3%%
*>5<;?56%E6F>5F?5?<E657;C;K3%
SKI?886% 7AAI5K% ;@% F?<;>@<K% [;<E% AE57@;A% 5>@?8%
D?;8I5>.% 4I<% 3?6% ?8K7% 4>% CI>% <7% 7K<>79>@>K;K% #I59>56%;K%;@C;A?<>C%D75%K63F<73?<;A%F?<;>@<K%75%
 W    F?<;>@<K%I@5>KF7@K;=>%<7%3>C;A?8%3?@?9>3>@<%h%
36>873?%% 37@<EK% F7K<% T% <5?@KF8?@<% % >;<E>5% Z% m% 98?@C%
F?5?<E657;C>A<736% [;<E% ;3F8?@<?<;7@% 7D% 3;@A>C%
1?<E7FE6K;78796%;@%5>@?8%D?;8I5>%% 98?@CK%;@<7%3IKA8>+%

P@A5>?K>C%FE7KFE?<>%4>A?IK>%7D%F775%5>@?8% %
>GA5><;7@% />A5>?K>C% K>5I3% A?8A;I3.%
C>A5>?K>C%9I<%?4K75F<;7@%7D%A?8A;I3%CI>%<7%
C>A5>?K>C% 5>@?8% UTE6C57G68?<;7@% 7D% =;<?3;@%
/`% ?@C% C>A5>?K>C% 5>@?8% A8>?5?@A>% 7D% 1*N%
45>?LC7[@%F57CIA<K+%%

28;@;A?886% 3?@;D>K<K% ?K% FK6AE;?<5;A% C;K75C>5K.%

E>?C?AE>.% 3IKA8>% [>?L@>KK.% [>;9E<% 87KK.%
D?<;9I>.% 5>@?8% 7K<>7C6K<57FE6% H47@>% 5>K75F<;7@%
[;<E% F?<E7879;A% D5?A<I5>KJ% ?@C% K7D<% <;KKI>%
A?8A;D;A?<;7@K%H=>KK>8K.%<>@C7@K%?@C%l7;@<%KE>?<EKJ%%

*5>?<3>@<% ;K% C;5>A<>C% ?<% I@C>586;@9% C;K75C>5% %

FE7KFE?<>T4;@C;@9% ?@<?A;CK.% 75?8% A?8A;I3% ?@C%
=;<?3;@% /.% ;@A5>?K>C% A?8A;I3% C;?86K?<>% D75%
AE57@;A%5>@?8%;@KIDD;A;>@A6%F?<;>@<K+%%

#I59>56%;K%;@C;A?<>C%D75%I@A7@<5788>C%K63F<73K%%
>;<E>5% ZTmT98?@C% F?5?<E657;C>A<736% 75% MT98?@C%
F?5?<E657;C>A<736% [;<E% ;3F8?@<?<;7@% 7D% 3;@A>C%
98?@CK% ;@<7% K<>5@7A8>;C73?K<7;C% 75% D75>?53%
3IKA8>K%3?5L>C%46%?%KI59;A?8%A8;F+%

%
!"#$%&'(&)!*+!!!! ! ,-.,.,/.! ! ! ! ! ! /,!!