Differentiated Thyroid cancer Flashcards
What is the most common type of thyroid cancer?
Papillary
What is the second most common type?
Follicular
What do medullary cancers secrete?
Calcitonin
What is the most aggressive thyroid cancer?
Anaplastic.
Few months.
What drives differentiated thyroid cancers?
TSH
What do DTC secrete and take up?
Secrete thyroglobulin
Take up iodine
What does thyroglobulin do?
Contains T3/4
What is the pattern with men of developing thyroid cancer?
Risk gradually increases with age
How do DTC present?
Palpable nodules
Where would local metastasis be?
Cervical lymph nodes
Where else is important to examine for nodes?
Groin
How does papillary spread?
Lymphatics ++
Haematogenously - liver, bones, brain and lungs
What thyroid condition is papillary TC associated with?
Hashimoto’s thyroiditis
What is the prognosis for papillary or follicular?
95% at 10 years
What investigations are involved?
USS-FNA
Excisional biopsy
NOT MRI/CT
How are patient’s risk defined in NW?
Age
Metastases
Extent of primary tumour
Size of primary tumour
AMES low or high
What is the best surgical option for high AMES patients?
Total thyroidectomy
Why might calcium levels be low after a thyroidectomy?
Inadvertent removal of parathyroids
What are the dangers of hypocalcaemia?
Long QT syndrome
Tetany
seizures
When is whole body iodine scanning used?
High AMES with previous total thyroidectomy
When is whole body iodine scanning done?
3-6 months after thyroidectomy
Which medications need to be stopped before the scan?
T3/4 so biochemically is hypothyroid
Purpose is to raise TSH
What is given prior to the body scan?
Iodine as a capsule.
Where should iodine be rich on the scan?
Salivary glands
Stomach
Bladder
