Thyroid Cancer

Anthony Safi MEDIII

General Surgery Rotation
 Definition
• A gland located beneath the larynx that makes and stores hormones that
help regulate the heart rate, blood pressure, body temperature, and the
rate at which food is converted into energy.
 Surgical Anatomy
• Two lobes divided by an isthmus

• Two arteries, three veins.

• Two innervations.

• Recurrent laryngeal nerves.

• Parathyroid glands.

• Superior laryngeal nerve.

 Types of cancer
• Papillary adenocarcinoma

• Follicular adenocarcinoma

• Medullary carcinoma

• Anaplastic/undifferentiated carcinoma

• Hürthle cell carcinoma

• Primary Thyroid Lymphoma (Non-hodgkin’s lymphoma)

• Can also be secondary by direct invasion of adjacent structures

such as the esophagus
 Risk factors
• Prior exposure to neck radiation specially during childhood

• Cold nodules

• Female sex

• Age less than 20 or older than 70

• Firm and fixed solitary nodules

• A positive family history

• Rapidly growing nodules with hoarseness

 Papillary adenocarcinoma
• The 7 P’s of papillary thyroid
cancer:

1. Popular

2. Psammoma bodies

3. Palpable LN’s

4. Positive iodine intake

5. Positive prognosis

6. Postoperative I131 scan to

diagnose/treat metastases

7. Pulmonary metastases
 Papillary adenocarcinoma
• Lymphatic spread, slow growth, female to male ratio 3:1.

• Indications for surgery:

1. Thyroid lobectomy is the appropriate surgery for unifocal, papillary
tumours less than 1 cm and up to 4cm in diameter in the absence of
lymph node metastasis.

2. Total thyroidectomy and radio iodine ablation is considered in patients

that have a higher recurrence rate which is defined by tumor size, lymph
node metastasis and an age older than 45 years.

• Thyroid replacement post-op (levothyroxine) to suppress TSH.

• Thyroglobulin monitoring to check for any remnants or recurrences.

Follicular adenocarcinoma
• The 4 F’s of follicular thyroid
cancer:

1. Far away metastasis

2. Female to male ratio 3:1

3. FNA Not (tissue histology)

4. Favorable prognosis

• Positive iodine intake,

postoperative I131 scan,
Hematogenous spread,
malignancy defined by blood
vessel invasion.

• Treated by total thyroidectomy, if

 Medullary carcinoma
• The 4 M’s of medullary
carcinoma:

1. MEN II

2. aMyloid

3. Median LN dissection

4. Modified radical neck dissection

if lateral nodes are positive
 Medullary carcinoma
• Either hematogenous or lymphatic spread, equal age and sex
distribution, parafollicular C cells, calcitonin, poor iodine
uptake, FNA, RET proto-oncogene and pentagastrin test.

• Familial form: affects both lobes with C cell hyperplasia

• Sporadic form: unifocal, no associated hyperplasia.

• Prophylactic thyroidectomy is indicated in unaffected kindred

members with the germline RET mutation, even in childhood.
 Anaplastic carcinoma
• Also known as undifferentiated carcinoma usually arising from
previous differentiated thyroid cancers, rapidly enlarges and
metastasizes with compression and invasion of the trachea, with
a very poor 3year prognosis.

• Females and elderly more prone, giant and spindle cells on

histology, very poor iodine uptake and diagnosed by FNA, can
be confused with a lymphoma which has a much better
prognosis.

• Two way spread mainly to lungs, bones and brain.

• Small tumors treated by total thyroidectomy, radio iodine

ablation or chemotherapy.
Anaplastic carcinoma