Clinical features of thyroid malignancy

THYROID MALIGNANCYCLINICAL FEATURES

NEETHI.T.PROLL NO: 29

PAPILLARY CARCINOMA OF THYROID

CLINICAL FEATUTES• Thyroid swelling – soft or firm or hard solid or cystic solitary or multinodular

• Compression features are uncommon

• Often descrete lymphnodes in the neck (40%) are palpable

• This may present with secondaries in neck lymphnodes with occult primary

FOLLICULAR CARCINOMA

CLINICAL FEATURES

• Swelling in the neck- firm or hard and nodular

• Tracheal compression/ infiltration & stridor

• Dyspnoea, haemoptysis, chest pain when there are lung secondaries

• Hoarseness of voice if recurrent laryngeal nerve involvement occurs

• Absence of carotid pulsation, if lesion infiltrate into carotid sheath (positive berry’s sign)

• Pulsatile secondaries in skull and longbones

CLINICAL SCORING SYSTEMS

• AMES clinical scoring system

Based on Age distant Metastasis Extent of primary tumour Size of primary tumour

• AGES clinical scoring system

Based on Age pathologic Grade of the tumour Extent of the tumour Size of the tumour

Prgnostic risk classification for patientsbased on AMES or AGES

Risk

parameter LOW HIGH

age <40 >40

gender female male

extent No local extension, intrathyroidal, no capsular invasion

Capsular invasion, extrathyroidal extension

metastasis none Regional or distant

size <2 cm >4 cm

grade Well differentiated Poorly differentiated

ANAPLASTIC CARCINOMA CLINICAL FEATURES

• Swelling in thyroid region- rapidly progressive hard with involvement of isthmus and lateral

lobes• Stridor and hoarseness of voice due to

tracheal obstruction• Dysphagia• Fixity to the skin• Positive berry’s sign

MEDULLARY CARCINOMA

CLINICAL FEATURES

• Thyroid swelling often with enlargement of neck nodes

• Diarrhoea, flushing (30 %)

• Hypertension, pheochromocytoma, and mucosal neuromas when associated with MEN II syndrome

• Sporadic and familial types occur in adulthood • Cases associated with MEN II syndrome occur

in younger age group

• Paraneoplastic syndrome like cushing’s, carcinoids may be present.

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