Click here to load reader

Solitary thyroid nodule

  • View
    44

  • Download
    0

Embed Size (px)

DESCRIPTION

Solitary thyroid nodule. Hystory Low dose radiation Family hystory Physical exam. Diagnostic test. FNA 65% BENIGN 20%SUSPICIOUS 5%MALIGNANT 15%NONDIAGNOSTIC 1%FULSE POSITIVE 3%FULSE NEGATIVE. LABORATORY STUDIES. EUTHYROID TSH TG CALCITONIN CEA. IMAGING. SONOGRAPHY CT SCAN - PowerPoint PPT Presentation

Text of Solitary thyroid nodule

  • Solitary thyroid noduleHystoryLow dose radiationFamily hystoryPhysical exam

  • Diagnostic testFNA65% BENIGN20%SUSPICIOUS5%MALIGNANT15%NONDIAGNOSTIC1%FULSE POSITIVE3%FULSE NEGATIVE

  • LABORATORY STUDIESEUTHYROIDTSHTGCALCITONINCEA

  • IMAGINGSONOGRAPHYCT SCANMRITHYROID SCAN

  • MANABNGEMENTMALIGNANT THYROIDECTOMYCYST aspiration

  • PAPILARY THYROID CANCER80% OF THYROID CA in iodine sufficient area and children and radiation exposed patients female:male ratio 2/1Age30-40EuthyroidLymphatic metastasisMetastasis to long bone liver brain

  • pathologySectionPsommama bodiesMultifocl 85%

  • Prognostic indicator95% 10years surPrognostic factors AgeHystologic gradeTumor sizeDifferentiationExternal thyroid invation& metastasis

  • Surgical treatment high risk patient = total or near total thyroidectomyMinimaly ptc = lobectomy isthmectomyIf no angioinvation no mutifocal no positive marginIn low risk patient type of surgery is cotraversy

  • Type of surgery in low riskTotal or near total

    Lobectomy isthmectomy

  • Follicular carcinoma10% of thyroid cancerOften in iodine deficiency areaF:m ratio = 3/150 years Pain is rareLymphadenopathy is rare5%1% hot nodule

  • FNAIn follicular is not diagnostic

  • pathologyVascular and capsular invationMinimally invasive tumor

  • Surgical treatment &prognosis Minimally invasive=lobectomy frankely invasive ca =total thyroidectomyPatient with angioinvation=total thyroidectomyNode disectoin if lymph node is + not prophylaxy

  • Hurthle cell ca3%of thyroid caSub type of follicularFna same as follicular Multifocal and multy center 30%rai uptake no or low Local lymph node 30% treatment same as ftc hurthle cell adenma=lobectomy hurthle cellca total thyroidectomySame as mtc routine central node disectionLateral node+=MNDRAI scan and ablation not effective

  • Post opperative manangment of differentiated thyroid caThyroid hormone

    TGSONO CT MRI of neck must be done in high risk patientRadioiodine therapyExternal beam radiotherapy& chemotherapy

  • Medullary thyroid cancer5% of thyroid caC-cellMTC is often sporadically 25% is familial15-20% lymphadenopathy at the time of diagnosisPain is commonDysphagea and dysnea and dysphonea may beMetastas to liver bone(osteoblastic) lungMf:m ratio1/1/2506oCalcitonin cea serotonin pr e2 f2alfa

  • MTCDIARHEACushing.s syn ectopic ACTH

  • PATHOLOGYIN SPORADIC 80%UNILATERAL IN FAMILIAL TYPE 90%BILATERAL AND MULTICENTERALAMYLOID IS DIAGNOSTIC

  • DIAGNOSISHYSTORYPHYSICAL EXAMESERUM CALCITONIN AND CEAFNA

  • TREATMENTGold standard therapy is total thyroidectomy if may be becouseBilateral central neck node disectionMND in node positive and tumor greater than 1/5 cmExternal radiotherapy is debate residual tumor unresectable recurenceRF or radiofrequency

  • Anaplastic ca1%Women70-80Rapidly enlarge neck massDysnea dysphonea dysphagea are commonFixed may be ulcerated often lymph node possitive

  • Diagnosis and treatmentFNA occasionally incisional biopsy Poor prognosis

  • limphomaNon-hdgkin b-cell typeMost commonly from chronic lymphocytic thyroiditisSymptom same anaplastic ca

  • diagnosisOften with FNANeedle core biopsy or open biopsy may be needed

  • treatmentChemothrapy Radiotherapythyroidectomy

  • Metastatic caIs rareKidneyBreastLungmelanoma

  • Complication of thyroid surgeryRLN INJERY EXTERNAL BERANCH OF SUP LARING N INJERYNECK SYMPATHETIC NERVE INJURYHYPOCALCEMIA AND HYPOPARATHYROIDISMHEMATOMA HEMORHAGESEROMACELULITIS INFECTIONJUGULAR VEIN AND CAROTID AND ESOPHGUSE INJERY IS RARE

  • ..

    *

Search related