MCQ - Thyroid malignancy II

Ultimobranchial bodiesQ and secrete calcitoninQ

• • High level of serum CalcitoninQ and CEAQ
• • Cervical lymph nodes at time of presentation (LN involvement, thyroid and blood borne metastases occurs early)Q
• • DiarrheaQ at the time of presentation.
• • Amyloid Q in stroma histologically.
• • MEN setting

• Pheochromocytoma must be operated on firstQ.
• Generally (>50%) bilateral.
• Total thyroidectomyQ is the treatment of choice - because of the high incidence of multicentricity, the more aggressive course, and the fact that 131I therapy usually is not effective
• Central compartment nodes frequently are involved early in the disease process, so that a bilateral central neck node dissection should be routinely performedQ.

• In patients with tumors >1 cm, ipsilateral prophylactic modified radical neck dissection is recommended because >60% of these patients have nodal metastasesQ.
• If ipsilateral nodes are positive, a contralateral node dissectionQ should be performed

It should be removed, biopsied to confirm that it is a parathyroid, and then autotransplanted to the forearm of the nondominant armQ.

• MEN-2A - Before 5 yearsQ
• MEN-2B - Before 1 yearQ

• Central neck dissection is usually avoided in childrenQ. Indications of central neck dissection are -
• 1. Raised calcitoninQ
• 2. USG suggesting thyroid cancerQ >5 mm
• 3. Evidence of LN metastasis

Women in 7th and 8th decadeQ , long-standing neck mass, which rapidly enlarges and may be painfulQ. Associated with dysphagia

Characteristic giant and multinucleated cellsQ

• Thyroidectomy for resectable massQ
• Combined radiation and chemotherapy in an adjuvant setting - prolonged survivalQ.
• TracheostomyQ to alleviate airway obstruction.

• CA BreastQ > CA Lung if diagnosed on autopsy
• RCCQ >CA Breast > CA Lung, If thyroid metastases is detected pre-mortem

NHL B cellQ type

• • PainlessQ and associated with feverQ
• • Virtually never have hyperthyroidism but frequently have hypothyroidismQ.
• • Hypothyroid patients have evidence of autoimmune thyroiditis or Hashimoto’s thyroiditisQ

External beam radiotherapy + ChemotherapyQ

• Age <40Q years >40 years
• Metastasis None Regional or distantQ
• Size <4 cmQ >4 cm
• Grade Well differentiated Poorly differentiatedQ
• Extent No local extension, intrathyroidal, no capsular Invasion, Capsular invasion, extrathyroidal extensionQ

• Microcalcification
• Absent halo
• IntraNodular vascularity
• Irregular margins
• Solid
• Hypoechogenicity
• Taller than width cells (Height) [@ MANISH]

• • STN are 4 times more common in womenQ than in men.
• • There is nodular hyperplasiaQ (not the diffuse hyperplasia)
• • Nodules in younger patients are more likely to be neoplasticQ than those in older patients.
• • History of radiation exposure increases the risk of malignancyQ.
• • Cold nodules (don’t take up radioactive iodine) are more likely to be malignant (15-20%)Q than hot (take up radioactive iodine) nodules (1-3%)Q
• • STN are removed surgicallyQ to exclude malignancy
• • Initial investigation done in STN is thyroid function test (TFT) Q.
• • Investigation of choice in STN for diagnosis is FNACQ.

• • MC solitary thyroid nodule is benign colloid noduleQ, it accounts for 60% cases of solitary thyroid nodule.
• • 2nd MC cause of solitary thyroid nodule is follicular adenoma (30%)Q.

• • History of exposure to low-dose ionizing radiationQ to the thyroid gland places the patient at increased risk for developing papillary thyroid cancerQ.
• • Risk is maximum 20 to 30 years after exposureQ

• • If the cyst persists after three attempts at aspirationQ
• • Cysts >4 cm in diameterQ
• • Complex cysts with solid and cystic components (higher incidence of malignancy, 15%).

• • Observation with serial ultrasound and Tg measurementsQ.
• • If the nodule enlarges, repeat FNAC often is indicated.
• • L-thyroxine - serum TSH level between 0.1 and 1.0 U/mL
• • Approximately 50% of these nodules decrease in size in response to the TSH suppression of this regimen, and others may not continue to grow, but it is most effective for nodules <3 cmQ.
• • Hemithyroidectomy: If a nodule enlarges on TSH suppression, causes compressive symptoms, or for cosmetic reasonsQ.
• • Total thyroidectomy: Patient who has had previous irradiation of the thyroid gland or has a family history of thyroid cancer, because of the high incidence of thyroid cancer and decreased reliability of FNAC in this settingQ.

Adult progeroid syndromeQ associated with Familial Cancer Syndromes Involving Nonmedullary Thyroid Cancer

Cutaneous and cardiac myxomas, breast and adrenal tumorsQ

Polyostotic fibrous dysplasia, endocrine abnormalities, café-au-lait spotsQ