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Carcinoma Thyroid: Diagnosis and Management: Professor Ravi Kant
Carcinoma Thyroid: Diagnosis and Management: Professor Ravi Kant
adenopathy.
being malignant.
• Cancer is more likely in a nodule if:
a) Male sex or children
b) History of previous radiation exposure
c) Age > 60 yrs
d) Cold nodule
e) In a patient with grave’s disease
f) family history of MEN
1. Fine needle aspiration cytology
metastasis.
- 99m
Tc 1,2-bis ethane (99mTc Tetrofosmin)
- Fluoro - 18 -deoxyglucose
Isotope imaging (cont.)
• 80-85% of all thyroid nodules are hypofunctional but only
10-15% of hypofunctional nodules are malignant so scanning
has a low specificity.
• Important modality to detect cancer recurrence and
metastases in the post operative period.
• Ablation of any remnant by radioiodine and withdrawal of
supplementary thyroid hormone will increase the levels of
TSH and hence the ability of the metastasis to pickup
radioiodine and consequently their chances of being picked
up in the scan.
6. X-ray neck
carcinoma
7. CT and MRI
• Extrathyroid tumor extension and/or invasion
• Destruction, infiltration or displacement of larynx, trachea,
esophagus, carotids
• Retrosternal extension
• Can assess cervical adenopathy
• Can locate local and distant metastatic deposits.
• CT has a advantage because of its wide availability,
familiarity and lower cost.
8. Genetic markers in thyroid cancer
• RET/PTC
• RAS mutations
• Thyroglobulin mRNA
PRIMARY TREATMENT
Papillary thyroid carcinoma (PTC)
which do not extend beyond the thyroid capsule and are not
metastatic or angioinvasive.
definitive procedure.
Papillary thyroid carcinoma (PTC) (cont.)
- Multifocal disease
distant tumor.
residual disease.
Papillary thyroid carcinoma (PTC) (cont.)
risk patients.
Adjuvant therapy
1. Thyroid hormone:
• Growth of FCDC cells is TSH dependent so administration
serum TSH.
• Long term levothyroxine suppressive therapy may have
thyroidectomy”.
• Used as an adjunct to surgical treatment when the
a) 131
I may destroy microscopic cancer cells
• 131
I WBS generally performed 48-72 hrs. after giving
- Local recurrence