Download Solitary thyroid nodule

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
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LABORATORY STUDIES
EUTHYROID
TSH
TG
CALCITONIN
CEA
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IMAGING
SONOGRAPHY
CT SCAN
MRI
THYROID SCAN
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MANABNGEMENT
MALIGNANT THYROIDECTOMY
CYST
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PAPILARY THYROID CANCER
80% OF THYROID CA in iodine sufficient
area and children and radiation exposed
patients
female:male ratio 2/1
Age30-40
Euthyroid
Lymphatic metastasis
Metastasis to long bone liver brain
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pathology
Section
Psommama bodies
Multifocl 85%
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Prognostic indicator
95% 10years sur
Prognostic factors
Age
Hystologic grade
Tumor size
Differentiation
External thyroid invation& metastasis
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Surgical treatment
high risk patient = total or near total 
thyroidectomy
Minimaly ptc = lobectomy isthmectomy 
If no angioinvation no mutifocal no positive
margin
In low risk patient type of surgery is cotraversy
Type of surgery in low risk
Total or near total
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Lobectomy isthmectomy
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Follicular carcinoma
10% of thyroid cancer
Often in iodine deficiency area
F:m ratio = 3/1
50 years
Pain is rare
Lymphadenopathy is rare5%
1% hot nodule
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FNA
In follicular is not diagnostic
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pathology
Vascular and capsular invation
Minimally invasive tumor
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Surgical treatment &prognosis
Minimally invasive=lobectomy
frankely invasive ca =total thyroidectomy
Patient with angioinvation=total
thyroidectomy
Node disectoin if lymph node is + not
prophylaxy
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Hurthle cell ca
3%of thyroid ca
Sub type of follicular
Fna 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
thyroidectomy
Same asmtc routine central node disection
Lateral node+=MND
RAI scan and ablation not effective
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Post opperative manangment of
differentiated thyroid ca
Thyroid hormone
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TG
SONO CT MRI of neck must be done in
high risk patient
Radioiodine therapy
External beam radiotherapy& chemotherapy
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Medullary thyroid cancer
5% of thyroid ca
C-cell
MTC is often sporadically 25% is familial
15-20% lymphadenopathy at the time of diagnosis
Pain is common
Dysphagea and dysnea and dysphonea may be
Metastas to liver bone(osteoblastic) lung
M
f:m ratio1/1/2
50—6o
Calcitonin cea serotonin pr e2 f2alfa
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MTC
DIARHEA
Cushing.s syn ectopic ACTH
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PATHOLOGY
IN SPORADIC 80%UNILATERAL
INFAMILIAL TYPE 90%BILATERAL AND
MULTICENTERAL
AMYLOID IS DIAGNOSTIC
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DIAGNOSIS
HYSTORY
PHYSICAL EXAME
SERUM CALCITONIN AND CEA
FNA
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TREATMENT
Gold standard therapy is total thyroidectomy
if may be becouse
Bilateral central neck node disection
MND in node positive and tumor greater than
1/5 cm
External radiotherapy is debate residual
tumor unresectable recurence
RF or radiofrequency
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Anaplastic ca
1%
Women
70-80
Rapidly enlarge neck mass
Dysnea dysphonea dysphagea are common
Fixed may be ulcerated often lymph node
possitive
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Diagnosis and treatment
FNA occasionally incisional biopsy
Poor prognosis
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limphoma
Non-hdgkin b-cell type 
Most commonly from chronic lymphocytic 
thyroiditis
Symptom same anaplastic ca
diagnosis
Often with FNA
Needle core biopsy or open biopsy may be
needed
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treatment
Chemothrapy
Radiotherapy
thyroidectomy
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Metastatic ca
Is rare
Kidney
Breast
Lung
melanoma
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Complication of thyroid surgery
RLN INJERY
EXTERNAL BERANCH OF SUP LARING N
INJERY
NECK SYMPATHETIC NERVE INJURY
HYPOCALCEMIA AND
HYPOPARATHYROIDISM
HEMATOMA HEMORHAGE
SEROMA
CELULITIS INFECTION
JUGULAR VEIN AND CAROTID AND
ESOPHGUSE INJERY IS RARE
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