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Thyroid Carcinoma: Abhishek Thakur 1610050
Thyroid Carcinoma: Abhishek Thakur 1610050
Frequency
17,000 cases diagnosed annually.
men. Peak incidence 30-40s. Papillary 80%, follicular 10%, medullary 510%, anaplastic 1-2%.
Etiology/Risk Factors
Arise from the two cell types in the gland.
and anaplastic. C-cells produce medullary. Radiation exposure (papillary). Populations with low dietary iodine have a higher proportion of follicular and anaplastic cancers.
History
Painless, palpable solitary nodule.
5% are malignant
Age at presentation (>60 and <30) Rapid growth
History
Malignant nodules usually painless
involvement. Dysphagia Heat intolerance, palpitations suggest autonomously functioning nodules. Family history (medullary).
The Goal..
Differentiate malignant from benign.
10% indeterminate, 17% non-diagnostic. Sensitivity 83%, specificity 92% False positive 2.9%, negative 5.2%
Laboratory
TSH sensitive for hypo and
hyperthyroidism, but does not rule out malignancy. TFTs not indicated in work up initially. Serum thyroglobulin used as tumor marker post op.
Imaging
Ultrasound: solid vs. Cystic, for FNA accuracy,
for monitoring of benign lesions. Scans: radioiodine scans determines function of the nodule. Cold nodules are those that dont take up iodine123, hot ones are the opposite. CT and MRI not used routinely.
Papillary Carcinoma
Most common (80%)
Papillary Carcinoma
Pathology:Unencapsulated, arborizing
papillae. Well differentiated, rare mitoses. 50% have psammoma bodies (calcific concretions, circular laminations. Multicentric with tumor present in contralateral lobe as well.
Papillary Carcinoma
Local invasion through capsule, invading
trachea, nerve, causing dyspnea, hoarseness. Propensity to spread to the cervical lymph nodes. Clinically evident in 1/3 patients. Distant spread to bone, lungs.
Follicular Carcinoma
Second most common (10%)
papillary Late 40s Also TSH sensitive, takes up iodine, produces thryroglobulin.
Follicular Carcinoma
Pathology: round, encapsulated, cystic
changes, fibrosis, hemorrhages. Microscopically, neoplastic follicular cells. Differentiated from follicular adenomas by the presence of capsule invasion,vascular invasion. Cannot reliably diagnose based on FNA.
Follicular Carcinoma
Local invasion is similar to papillary cancer
with the same presentation. Cervical metastases are uncommon. Distant metastases is significantly higher (20%), with lung and bone most common sites.
continues. Surgical excision whenever possible. Total thyroidectomy has been mainstay (all apparent thyroid tissue removed). Complications include nerve damage bilaterally, parathyroid injury bilaterally. Afterwrds, get radioiodine scan, ablation if residual disease or recurrence.
reduce the above complications. Subtotal thyroidectomy( small portion of thyroid tissue opposite the side of malignancy is left in place) and postop ablation. Thyroid lobectomy and isthmectomy also a viable option with small tumors
and tumor after thyroidectomy. Given in diagnostic doses and therapeutic doses to ablate tissue.
ablation. Low TSH levels reduce tumor growth rates and reduce recurrence rates. Follow-up 6 months with thyroglobulin levels and repeat scans. Thyroglobulin is good because well differentiated tumors produce it.
Prognosis
Age: at diagnosis. Cancer related death
more common if patient is older than 40 years. Recurrences common in patients diagnosed when they were less than 20 years or older than 60 years. Tumors greater than 4 cm have higher recurrence, death.
Hurthle Cell
A variant of follicular, also known as oncocytic
carcinoma. More common in women than men, presents in 5th decade of life. Same clinical presentation. Cannot be diagnosed on FNA Does not take up iodine, so treated aggressively. Thyroid suppression and radioiodine dont work.
Lymphoma of thyroid
Obstructive goiter