Thyroid Carcinoma

SURGE

Thyroid carcinoma

Aetiology

1. papillary carcinoma - History of irradiation— Papillary (including mixed papillary & follicular) - 75% ++ LYMPH Thyroglossal cyst—papillary carcinoma. Hashimotos thyroiditis—lymphoma and papillary carcinoma.

2. follicular carcinoma - Hx of longstanding multinodular goiter - 16% ++ METASTASES

3. medullary carcinoma thyroid.- Family hx 20%? — 5%

4. Undifferentiated (Anaplastic Carcinoma) - 3%

5. Miscellaneous ( lymphoma, fibrosarcoma, squamous cell ca, teratoma, & metastatic ca)— 1%

Management of Papillary & Follicular Carcinoma

• Low risk group:
  1. Age <45
  2. Primary *lesions <1cm *
  3. No evidence of intra/ extra-glandular spread.

Treatment: Lobectomy + isthemectomy

• All other high risk: Total thyroidectomy.
  • Modified neck dissection for lymphatic spread.
  • Surgery followed by RAI ablation therapy
  • Patient placed on L-thyroxine suppressive therapy
  • Regular F/U: Thyroglobulin, US, whole body scan.

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IMG

Thyroid ultrasound:

• to assess for sonographic signs of thyroid malignancy  
• Irregular margins 
• Taller-than-wide shape
• Microcalcifications within nodules
• Extrathyroidal growth

Thyroid scintigraphy

Indications

• Thyroid nodule(s) with ↓ TSH levels 
• Multinodular thyroids (to identify nodules that require FNAC)

Supportive findings:  decreased or no radiotracer uptake (i.e., hypofunctioning or nonfunctioning nodules, referred to as cold nodules)

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Solid, hypoechoic nodules with irregular margins, microcalcifications, taller-than-wide shape, extrathyroidal growth, and/or cervical lymphadenopathy should raise suspicion for malignancy and require further evaluation with FNAC.

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Highly suspicious malignancies

A-Solid thyroid nodule with microcalcifications

Ultrasound thyroid (longitudinal plane) A solid nodule in the upper pole has ill-defined margins and contains multiple microcalcifications.

The presence of microcalcifications increases suspicion for malignancy

B-Mixed echogenicity thyroid nodule

Ultrasound thyroid (left lobe; longitudinal plane) A rounded mixed-echogenicity nodule with irregular (lobulated) margins contains hypoechoic and hyperechoic components.

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