Benign and malignant tumors of the thyroid gland

Question 1

Characteristics of benign tumors

Answer 1

A distinct solitary tumor nodule is more likely to be benign tumor.
Feel tenderness, size, shape and motility. Percuss for retrosternal extensions.
Ultrasound nodules to check for cysts.

Benign adenomas are often solitary and most often non-functional. Follicular adenoma.

Question 2

Diagnosis of benign tumors

Answer 2

Iodine 131 radioiodine uptake studies. Increased uptake is seen in diseases such as Grave’s or nodular goiter, whereas decreased uptake is seen in benign and malignant tumors. FNA is the mechanism of sampling.

Question 3

Characteristics of carcinomas

Answer 3

Have multiple modifications: papillary, follicular, medullary, anaplastic carcinomas, lymphoma

Question 4

Papillary carcinoma

Answer 4

Most common thyroid cancer. Histologically there are papillary projections into gland-like spaces. Orphan Annie nuclei and Psamomma bodies can also be seen. Best prognosis of all the cancers. Treated with thyroidectomy and T4 suppression

Question 5

Follicular carcinoma

Answer 5

Spread early via blood to bone and lungs. Treated with thyroidectomy and I131 T4 suppression.

Question 6

Medullary carcinoma

Answer 6

From C-cells of the thyroid (which produce calcitonin). Treated with thyroidectomy and nodule clearance

Question 7

Anaplastic carcinoma

Answer 7

Rare and with poor prognosis

Question 8

Lymphoma

Answer 8

Leads to stridor and dysphagia. Treated with chemotherapy.

Question 9

Post operative complications

Answer 9

May see development of nerve palsy, hypoparathyroidism, hypothyroidism and thyroid storm