Solitary thyroid noduleSolitary thyroid nodule

HystoryHystoryLow dose radiationLow dose radiation

Family hystoryFamily hystoryPhysical examPhysical exam

Diagnostic testDiagnostic test

FNAFNA65%65% BENIGNBENIGN20%SUSPICIOUS20%SUSPICIOUS5%MALIGNANT5%MALIGNANT15%NONDIAGNOSTIC15%NONDIAGNOSTIC1%FULSE POSITIVE1%FULSE POSITIVE3%FULSE NEGATIVE3%FULSE NEGATIVE

LABORATORY STUDIESLABORATORY STUDIES

EUTHYROIDEUTHYROIDTSHTSHTGTGCALCITONINCALCITONINCEACEA

IMAGINGIMAGING

SONOGRAPHYSONOGRAPHYCT SCANCT SCANMRIMRITHYROID SCANTHYROID SCAN

MANABNGEMENTMANABNGEMENT

MALIGNANT THYROIDECTOMYMALIGNANT THYROIDECTOMYCYSTCYST aspirationaspiration

PAPILARY THYROID CANCERPAPILARY THYROID CANCER

80%80% OF THYROID CA in iodine sufficient OF THYROID CA in iodine sufficient area and children and radiation exposed area and children and radiation exposed

patientspatients female:male ratio 2/1female:male ratio 2/1Age30-40Age30-40EuthyroidEuthyroidLymphatic metastasisLymphatic metastasisMetastasis to long bone liver brainMetastasis to long bone liver brain

pathologypathology

SectionSectionPsommama bodiesPsommama bodiesMultifocl 85%Multifocl 85%

Prognostic indicatorPrognostic indicator

95%95% 10years sur10years surPrognostic factorsPrognostic factors AgeAgeHystologic gradeHystologic gradeTumor sizeTumor sizeDifferentiationDifferentiationExternal thyroid invation& metastasisExternal thyroid invation& metastasis

Surgical treatmentSurgical treatment

high risk patient = total or near total high risk patient = total or near total thyroidectomythyroidectomy

Minimaly ptc = lobectomy isthmectomyMinimaly ptc = lobectomy isthmectomy

If no angioinvation no mutifocal no positive If no angioinvation no mutifocal no positive marginmargin

In low risk patient type of surgery is cotraversyIn low risk patient type of surgery is cotraversy

Type of surgery in low riskType of surgery in low risk

Total or near totalTotal or near total

Lobectomy isthmectomyLobectomy isthmectomy

Follicular carcinomaFollicular carcinoma

10%10% of thyroid cancerof thyroid cancerOften in iodine deficiency areaOften in iodine deficiency areaF:m ratio = 3/1F:m ratio = 3/15050 yearsyears Pain is rarePain is rareLymphadenopathy is rare5%Lymphadenopathy is rare5%1%1% hot nodulehot nodule

FNAFNA

In follicular is not diagnosticIn follicular is not diagnostic

pathologypathology

Vascular and capsular invationVascular and capsular invationMinimally invasive tumorMinimally invasive tumor

Surgical treatment &prognosisSurgical treatment &prognosis

Minimally invasive=lobectomyMinimally invasive=lobectomy frankely invasive ca =total thyroidectomyfrankely invasive ca =total thyroidectomyPatient with angioinvation=total Patient with angioinvation=total

thyroidectomythyroidectomyNode disectoin if lymph node is + not Node disectoin if lymph node is + not

prophylaxyprophylaxy

Hurthle cell caHurthle cell ca3%of thyroid ca3%of thyroid caSub type of follicularSub type of follicularFna same as follicularFna same as follicular Multifocal and multy center 30%rai uptake no or lowMultifocal and multy center 30%rai uptake no or low Local lymph node 30% treatment same as ftc hurthle Local lymph node 30% treatment same as ftc hurthle

cell adenma=lobectomy hurthle cellca total cell adenma=lobectomy hurthle cellca total thyroidectomythyroidectomy

Same as mtc routine central node disectionSame as mtc routine central node disectionLateral node+=MNDLateral node+=MNDRAI scan and ablation not effectiveRAI scan and ablation not effective

Post opperative manangment of Post opperative manangment of differentiated thyroid cadifferentiated thyroid ca

Thyroid hormoneThyroid hormone

TGTGSONO CT MRI of neck must be done in SONO CT MRI of neck must be done in

high risk patienthigh risk patientRadioiodine therapyRadioiodine therapyExternal beam radiotherapy& chemotherapyExternal beam radiotherapy& chemotherapy

Medullary thyroid cancerMedullary thyroid cancer5%5% of thyroid caof thyroid caC-cellC-cellMTC is often sporadically 25% is familialMTC is often sporadically 25% is familial15-20%15-20% lymphadenopathy at the time of diagnosislymphadenopathy at the time of diagnosisPain is commonPain is commonDysphagea and dysnea and dysphonea may beDysphagea and dysnea and dysphonea may beMetastas to liver bone(osteoblastic) lungMetastas to liver bone(osteoblastic) lungMMf:m ratio1/1/2f:m ratio1/1/25050——6o6oCalcitonin cea serotonin pr e2 f2alfaCalcitonin cea serotonin pr e2 f2alfa

MTCMTC

DIARHEADIARHEACushing.s syn ectopic ACTHCushing.s syn ectopic ACTH

PATHOLOGYPATHOLOGY

IN SPORADIC 80%UNILATERALIN SPORADIC 80%UNILATERAL IN FAMILIAL TYPE 90%BILATERAL IN FAMILIAL TYPE 90%BILATERAL

AND MULTICENTERALAND MULTICENTERALAMYLOID IS DIAGNOSTICAMYLOID IS DIAGNOSTIC

DIAGNOSISDIAGNOSIS

HYSTORYHYSTORYPHYSICAL EXAMEPHYSICAL EXAMESERUM CALCITONIN AND CEASERUM CALCITONIN AND CEAFNAFNA

TREATMENTTREATMENT

Gold standard therapy is total thyroidectomy Gold standard therapy is total thyroidectomy if may be becouseif may be becouse

Bilateral central neck node disectionBilateral central neck node disectionMND in node positive and tumor greater thanMND in node positive and tumor greater than 1/51/5 cmcmExternal radiotherapy is debate residual External radiotherapy is debate residual

tumor unresectable recurencetumor unresectable recurenceRF or radiofrequencyRF or radiofrequency

Anaplastic caAnaplastic ca

1%1%WomenWomen70-8070-80Rapidly enlarge neck massRapidly enlarge neck massDysnea dysphonea dysphagea are commonDysnea dysphonea dysphagea are commonFixed may be ulcerated often lymph node Fixed may be ulcerated often lymph node

possitivepossitive

Diagnosis and treatmentDiagnosis and treatment

FNA occasionally incisional biopsyFNA occasionally incisional biopsy Poor prognosisPoor prognosis

limphomalimphoma

Non-hdgkin b-cell typeNon-hdgkin b-cell typeMost commonly from chronic lymphocytic Most commonly from chronic lymphocytic

thyroiditisthyroiditis

Symptom same anaplastic caSymptom same anaplastic ca

diagnosisdiagnosis

Often with FNAOften with FNANeedle core biopsy or open biopsy may be Needle core biopsy or open biopsy may be

neededneeded

treatmenttreatment

ChemothrapyChemothrapy RadiotherapyRadiotherapythyroidectomythyroidectomy

Metastatic caMetastatic ca

Is rareIs rareKidneyKidneyBreastBreastLungLungmelanomamelanoma

Complication of thyroid surgeryComplication of thyroid surgeryRLN INJERYRLN INJERY EXTERNAL BERANCH OF SUP LARING N EXTERNAL BERANCH OF SUP LARING N

INJERYINJERYNECK SYMPATHETIC NERVE INJURYNECK SYMPATHETIC NERVE INJURYHYPOCALCEMIA AND HYPOCALCEMIA AND

HYPOPARATHYROIDISMHYPOPARATHYROIDISMHEMATOMA HEMORHAGEHEMATOMA HEMORHAGESEROMASEROMACELULITIS INFECTIONCELULITIS INFECTIONJUGULAR VEIN AND CAROTID AND JUGULAR VEIN AND CAROTID AND

ESOPHGUSE INJERY IS RAREESOPHGUSE INJERY IS RARE

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