Podcast
Questions and Answers
What is the half-life of radioiodine used in ablation?
What is the half-life of radioiodine used in ablation?
High levels of S. Thyroglobulin are always reliable for diagnosing recurrence of PTC.
High levels of S. Thyroglobulin are always reliable for diagnosing recurrence of PTC.
False
What are the main treatment options for radioiodine resistant DTC?
What are the main treatment options for radioiodine resistant DTC?
Immunotherapy, External beam radiotherapy, Chemotherapy
___ is the second most common thyroid cancer.
___ is the second most common thyroid cancer.
Signup and view all the answers
Match the following terms with their descriptions:
Match the following terms with their descriptions:
Signup and view all the answers
What is a common characteristic of Hurthle cell carcinoma compared to follicular thyroid carcinoma (FTC)?
What is a common characteristic of Hurthle cell carcinoma compared to follicular thyroid carcinoma (FTC)?
Signup and view all the answers
Females have a lower incidence of thyroid issues compared to males.
Females have a lower incidence of thyroid issues compared to males.
Signup and view all the answers
What type of thyroid surgery is indicated when there is a need for diagnosis during surgery?
What type of thyroid surgery is indicated when there is a need for diagnosis during surgery?
Signup and view all the answers
Hurthle cell carcinoma is characterized by the presence of ______ which is rich in mitochondria.
Hurthle cell carcinoma is characterized by the presence of ______ which is rich in mitochondria.
Signup and view all the answers
Match the following conditions with their characteristics:
Match the following conditions with their characteristics:
Signup and view all the answers
What is the primary treatment for localized thyroid disease?
What is the primary treatment for localized thyroid disease?
Signup and view all the answers
The incidence of thyroid lymphoma primarily occurs in individuals in their 5th to 7th decades of life.
The incidence of thyroid lymphoma primarily occurs in individuals in their 5th to 7th decades of life.
Signup and view all the answers
What is the first line treatment regimen for thyroid lymphoma?
What is the first line treatment regimen for thyroid lymphoma?
Signup and view all the answers
The most common type of thyroid lymphoma is _____ .
The most common type of thyroid lymphoma is _____ .
Signup and view all the answers
Match the following treatments with their descriptions:
Match the following treatments with their descriptions:
Signup and view all the answers
What is the primary use of the AGES system in thyroid cancer prognosis?
What is the primary use of the AGES system in thyroid cancer prognosis?
Signup and view all the answers
Anaplastic carcinoma of the thyroid is the most common type of thyroid cancer.
Anaplastic carcinoma of the thyroid is the most common type of thyroid cancer.
Signup and view all the answers
What is the most common site for distant metastases in anaplastic thyroid carcinoma?
What is the most common site for distant metastases in anaplastic thyroid carcinoma?
Signup and view all the answers
The MACIS system evaluates the __________ of original surgical resection.
The MACIS system evaluates the __________ of original surgical resection.
Signup and view all the answers
Match the clinical features with their corresponding descriptions:
Match the clinical features with their corresponding descriptions:
Signup and view all the answers
Which of the following tumors is most commonly associated with MEN I Syndrome?
Which of the following tumors is most commonly associated with MEN I Syndrome?
Signup and view all the answers
MEN 2B Syndrome is characterized by more aggressive Medullary Thyroid Carcinoma compared to MEN 2A.
MEN 2B Syndrome is characterized by more aggressive Medullary Thyroid Carcinoma compared to MEN 2A.
Signup and view all the answers
What gene is involved in MEN I Syndrome?
What gene is involved in MEN I Syndrome?
Signup and view all the answers
In MEN 2A, parathyroid abnormalities are most often seen as _____ rather than hyperplasia.
In MEN 2A, parathyroid abnormalities are most often seen as _____ rather than hyperplasia.
Signup and view all the answers
Match the following features to the correct syndrome:
Match the following features to the correct syndrome:
Signup and view all the answers
What is the most common type of thyroid cancer?
What is the most common type of thyroid cancer?
Signup and view all the answers
DTC has a better prognosis for individuals over 55 years of age.
DTC has a better prognosis for individuals over 55 years of age.
Signup and view all the answers
Name one genetic mutation commonly associated with papillary thyroid carcinoma.
Name one genetic mutation commonly associated with papillary thyroid carcinoma.
Signup and view all the answers
The ratio of female to male incidence of differentiated thyroid cancer is ______.
The ratio of female to male incidence of differentiated thyroid cancer is ______.
Signup and view all the answers
Match the risk factors for PTC with their descriptions:
Match the risk factors for PTC with their descriptions:
Signup and view all the answers
What is a prerequisite for performing a whole body iodine scan post-surgery?
What is a prerequisite for performing a whole body iodine scan post-surgery?
Signup and view all the answers
Total thyroidectomy requires different criteria than hemithyroidectomy.
Total thyroidectomy requires different criteria than hemithyroidectomy.
Signup and view all the answers
What surgery is indicated for patients with PTC involving Level 6 and other neck lymph nodes?
What surgery is indicated for patients with PTC involving Level 6 and other neck lymph nodes?
Signup and view all the answers
A minimum total thyroidectomy is indicated for patients with ________ spread.
A minimum total thyroidectomy is indicated for patients with ________ spread.
Signup and view all the answers
Match the type of thyroid surgery with its description:
Match the type of thyroid surgery with its description:
Signup and view all the answers
Which substance is primarily secreted by medullary thyroid carcinoma (MTC)?
Which substance is primarily secreted by medullary thyroid carcinoma (MTC)?
Signup and view all the answers
Sporadic medullary thyroid carcinoma is usually more aggressive than familial medullary thyroid carcinoma.
Sporadic medullary thyroid carcinoma is usually more aggressive than familial medullary thyroid carcinoma.
Signup and view all the answers
What is the most common site for hematogenous spread of medullary thyroid carcinoma?
What is the most common site for hematogenous spread of medullary thyroid carcinoma?
Signup and view all the answers
MTC arises from ___________ cells in the thyroid.
MTC arises from ___________ cells in the thyroid.
Signup and view all the answers
Match the following symptoms with their causes:
Match the following symptoms with their causes:
Signup and view all the answers
Which of the following microscopic features is associated with Papillary Thyroid Carcinoma (PTC)?
Which of the following microscopic features is associated with Papillary Thyroid Carcinoma (PTC)?
Signup and view all the answers
Psammoma bodies are only observed in Papillary Thyroid Carcinoma.
Psammoma bodies are only observed in Papillary Thyroid Carcinoma.
Signup and view all the answers
What is the primary diagnostic procedure used for thyroid nodules?
What is the primary diagnostic procedure used for thyroid nodules?
Signup and view all the answers
The most common site for haematogenous metastases in thyroid carcinoma is the __________.
The most common site for haematogenous metastases in thyroid carcinoma is the __________.
Signup and view all the answers
Match the following tumors with their associated features:
Match the following tumors with their associated features:
Signup and view all the answers
Which type of surgical procedure involves the complete removal of the thyroid gland along with neck dissection?
Which type of surgical procedure involves the complete removal of the thyroid gland along with neck dissection?
Signup and view all the answers
Medullary thyroid cancer (MTC) can absorb iodine during whole body scanning.
Medullary thyroid cancer (MTC) can absorb iodine during whole body scanning.
Signup and view all the answers
What is monitored through calcitonin levels during follow-up for thyroid cancer?
What is monitored through calcitonin levels during follow-up for thyroid cancer?
Signup and view all the answers
The most common type of thyroid cancer is _____ .
The most common type of thyroid cancer is _____ .
Signup and view all the answers
Match the following types of thyroid cancer with their associated characteristics:
Match the following types of thyroid cancer with their associated characteristics:
Signup and view all the answers
Which of the following is a risk factor for follicular thyroid cancer?
Which of the following is a risk factor for follicular thyroid cancer?
Signup and view all the answers
Radiotherapy is not considered in the management of advanced thyroid cancer.
Radiotherapy is not considered in the management of advanced thyroid cancer.
Signup and view all the answers
What type of hereditary syndrome is associated with Medullary thyroid cancer (MTC)?
What type of hereditary syndrome is associated with Medullary thyroid cancer (MTC)?
Signup and view all the answers
Study Notes
Active Space
- Whole body scan to check for residual disease or metastasis
Radioiodine Ablation (RIA)
- Uses β rays
- Half-life is 7-8 days
- Indicated for residual disease, metastases, positive lymph nodes, and persistently high thyroglobulin following surgery
TSH Suppression
- Suppresses TSH levels to the lower limit of normal with thyroxine
- Reduces the recurrence of papillary thyroid carcinoma
- Requires lifelong follow-up
- Involves regular neck ultrasound scans and monitoring thyroglobulin levels
- If thyroglobulin levels are elevated, suspect papillary thyroid carcinoma recurrence and perform a whole body iodine scan
Radioiodine Resistant DTC
- May necessitate different treatment approaches
- Immunotherapy with sorafenib or lenvatinib
- External beam radiotherapy
- Chemotherapy with doxorubicin
Follicular Thyroid Carcinoma (FTC)
- 2nd most common thyroid cancer
- Most common thyroid cancer in iodine-deficient areas
- Genetic factors include upregulation of miRNA-197 and 346, and mutations in PTEN and BAX genes
Hurthle Cell Carcinoma
- Separate entity from FTC
- Occurs predominantly in the 6th and 7th decade of life
- Distinguished by the presence of oxyphilic Hürthle cells rich in mitochondria
- More aggressive than FTC
- Less radioactive avid than other differentiated thyroid cancers
- Treatment is similar to papillary thyroid carcinoma
- Prognosis is poorer than FTC
Thyroid Lymphoma
- Rare
- Occurs most often in the 5th and 7th decade
- Risk factor is long-standing Hashimoto's or lymphocytic thyroiditis
- Clinical presentation: thyroid swelling, weight loss, fever, night sweats, itching
- Diagnosis involves core or Trucut biopsy as FNAC is insufficient
- Treatment is primarily chemotherapy
- First-line chemotherapy regimen is R-CHOP
- Surgery is only indicated for residual or recurrent disease
- Most common type is diffuse large B-cell lymphoma (DLBCL)
Prognostic Indicators for Well-Differentiated Thyroid Cancers
-
AGES System
- Considers age, histologic grade, extrathyroidal invasion, size, and tumor size
-
MACIS System
- Factors in age, metastasis, completeness of original surgical resection, extrathyroidal invasion, and size
Anaplastic Thyroid Carcinoma
- Least common type
- Worst prognosis
- Occurs most frequently in the 5th and 7th decade of life
- Genetic features: upregulation of miRNA 17-9a and mutations in p53 and β-catenin genes
- Clinical presentation: rapidly expanding hard neck swelling, history of multinodular goiter, pressure symptoms, stridor, dyspnea, hoarseness
- Differential diagnosis includes Riedel thyroiditis
- Commonly metastasizes to the lungs
- Investigations include FNAC and ultrasound-guided core biopsy
MEN (Multiple Endocrine Neoplasia) Syndromes
- Inherited disorders characterized by the development of tumors in multiple endocrine glands
-
MEN 1 Syndrome
- Related to mutations in the menin gene on chromosome 11
- Features include pituitary adenomas (prolactinoma is most frequent), parathyroid abnormalities, pancreatic endocrine tumors, collagenomas, adrenocortical tumors, and thymic tumors
-
MEN 2 Syndrome
- Caused by mutations in the RET proto-oncogene on chromosome 10
- Types: MTC only, MEN 2A, and MEN 2B
-
MEN 2A
- Most commonly associated with MTC
- Parathyroid abnormalities with adenoma or hyperplasia
- Can also present with megacolon or Hirschsprung disease
- Mutation is found in exon 634 of the RET proto-oncogene
-
MEN 2B
- Distinguished by more aggressive MTC
- Manifests with medullated corneal fibers, mucosal neuromas, and megacolon
- Mutation occurs in exon 918 of the RET proto-oncogene
Differentiated Thyroid Cancer (DTC)
- Includes papillary, follicular, and Hurthle cell carcinomas
- Arise from thyroid epithelial cells
- Accumulate iodine
- Poor prognosis in those diagnosed over 55 years old
- Stages are similar to those of anaplastic cancer
- Diagnosis is made through histopathology
Papillary Thyroid Carcinoma (PTC)
- Most prevalent type of thyroid cancer
- Best prognosis among thyroid cancers
Risk Factors for PTC
- Radiation exposure: nuclear fallout, head and neck radiotherapy, radioiodine ablation therapy at a young age
- Family History
- Obesity
- Genetic predispositions
- BRAF mutations (most frequent)
- GDNF mutations (glial-derived neurotrophic factor)
- RET/PTC mutations
Incidence of PTC
- Female to male ratio is 3:1
- Most commonly diagnosed in the 3rd and 5th decades of life
Clinical Presentation of PTC
- Thyroid swelling (most common)
- Often bilateral and multicentric
- Management: total thyroidectomy
Surgical Management of Papillary Thyroid Carcinoma
- Decisions about the extent of surgery depend on factors like tumor size, location, and spread
-
Hemithyroidectomy: Removal of one lobe of the thyroid gland
- Considerations: low-risk tumors, unilateral tumors, tumors less than 4 cm, no extrathyroidal spread, radiation-induced DTC, familial non-medullary thyroid cancer, multifocal bilateral DTC, extrathyroidal extension, T3 or T4 tumors, and positive level 6 lymph nodes
-
Minimum Total Thyroidectomy:
- Indicated for the same criteria as hemithyroidectomy
-
Total Thyroidectomy + Central Neck Dissection (CND): Removal of the entire thyroid gland and dissection of lymph nodes at level 6
- Considerations: same criteria as hemithyroidectomy
-
Total Thyroidectomy + CND + Modified Radical Neck Dissection (MRND): Includes the removal of the whole thyroid and a more extensive neck dissection
- Considerations: PTC involving level 6 and other neck lymph nodes
Strategies for Whole Body Iodine Scan
- Postoperative procedures to detect residual disease or metastasis
- Prerequisite: TSH greater than 20 for enhanced iodine uptake
- Traditional method: waiting 4-6 weeks after surgery and withholding thyroxine supplementation (patient experiences hypothyroidism during this period)
- Recombinant TSH injections: alternative approach to raising TSH levels
Medullary Thyroid Carcinoma (MTC)
- Originates from parafollicular or C cells
- Secretes:
- Calcitonin
- CEA (carcinoembryonic antigen): indicates dedifferentiation
- Chromogranin A
###Types of MTC
-
Sporadic
- Most common
- Typically diagnosed in the 4th to 6th decade of life
- Less aggressive
-
Familial
- Less frequent
- Diagnosed in the 2nd to 4th decade of life
- Often associated with MEN 2A and MEN 2B, which are characterized by more aggressive and multifocal disease
Clinical Features of MTC
- Thyroid swelling (most common)
- Atypical symptoms
Investigations for MTC
- Fine needle aspiration cytology
Symptoms Associated with MTC
- Diarrhea: due to excessive serotonin secretion
- Cushing syndrome: caused by ACTH secretion
- Flushing: associated with histamine release
Spread of MTC
- Lymphatic: involves level 6 lymph nodes
- Hematogenous: most frequently metastasizes to the liver
Lateral Aberrant Thyroid
- Enlargement of level 6 lymph nodes due to papillary thyroid carcinoma, even if the thyroid is not palpable
Thyroid Incidentaloma
- Incidentally diagnosed
- Size is less than 1cm
Investigations for Lateral Aberrant Thyroid and Thyroid Incidentaloma
- Fine needle aspiration cytology
Haematogenous Spread of Papillary Thyroid Carcinoma
- Lungs (most common)
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers essential treatments and management strategies for thyroid cancers, specifically focusing on Radioiodine Ablation, TSH suppression, and the approaches for different types of differentiated thyroid carcinoma. Learn about the indications, methods, and follow-up requirements crucial for managing thyroid cancer effectively.
