Helicase

Malfunctions

Incomplete
Separation of
DNA strands

Anomalies occur
in base pairing

Disrupt normal
hydrogen
bonding process

Incomplete correction of
replication by DNA errors

Persistent
mutations

Errors during
translation
synthesis

Specialized polymerase
bypass damaged site

Mutations

Unequal crossing over

during meiotic
recombination

Duplications or deletions
of genetic material

Inadequate telomere
maintenance by telomerase

Chromosomal
Instability

Cumulative errors in DNA

Replication processes

Cumulative errors in DNA

Replication processes

Genetic Mutations
 Mutation in RET Inherited autosomal dominant
Proto-Oncogene mutations in RET Proto-Oncogene

RET activation of RET-signaling

pathway

Dysregulation of MAPK and

P13K/AKT pathways

Uncontrolled cell growth

Proliferation in Thyroid
C-cells

Formation of tumor

Tumor grows

Palpable lump/nodules
in the neck

Tumor expands

Exerts pressure in the Exerts pressure to the Tumor induced Affects Nearby vocal
trachea esophagus angiogenesis cords and laryngeal
nerves

Airway becomes Exerts pressure to the

obstructed esophagus Supply nutrients and Disrupt normal nerve
oxygen to the rapidly function
dividing cancer cells

Interferes with the Lumen of esophagus

normal airflow narrows Affects motor control of
Airway becomes MTC cells invade the vocal cords
surrounding tissues
(lymph nodes, blood
Leads to difficulty in Partially obstructed by
vessels) Infiltration of laryngeal
breathing tumor
Airway becomes nerves

Cancer progresses
dyspnea Impedes the smooth
passage of food and Partial paralysis of one or
liquids both vocal cords

MTC cells metastasize

Changes in voice quality

Leads to difficulty in
swallowing MTC Cells release
excessive amount of
calcitonin Voice hoarseness
dysphagia

Elevated Calcitonin Levels

HYPOCALCEMIA

Less Ca+2 outside

cells, positive
charges inside the
cells (no changes)

Intracellular is
positively charged
(related to
depolarization)

Stimulation of neuron Altered Ion

and cardiac myocyte Permeability: Na+
influx
 Delayed repolarization

Increased neuronal Increased Cardiac

activity: excitability depolarization/ action

Inability to fire action

potentials frequently QT prolongation

Delayed neurotransmitter Abnormal rapid

release contraction: Premature
impulses occur

Disrupts synaptic
transmission Increased Cardiac
depolarization/ action

Altered sensory ability Neuromuscular

Hyperexcitability Premature impulses
occur

Tingling sensations in the Rare cases:

lips, tongue, fingers, and or Tetany
arrhythmia
feet Fatigue Torsades de Pointes
Cramps

Ventricular
Laryngospasm Tetany tachycardia
 Trousseau
sign
 Chvostek sign
Respiratory Distress