Differentiated Thyroid Cancer Flashcards
What does differentiated thyroid cancer ever to
Papillary and follicular variants with regards to histological and physiological appearances
What do most differentiated thyroid cancers do
Take up iodine and secrete thyroglobulin
What drives differentiated thyroid cancer
TSH
What does differentiated mean for the patients sake
Good prognosis compared to other solid tumours
What does differentiated mean for the clinicians view
The cancerous cells look very similar to normal thyroid cancer cells
Describe the incidence and prevalence of differentiated thyroid cancer in women
Rates increase from 15-40 years then plateau
Describe the incidence and prevalence of differentiated thyroid cancer in men
Steady increase with age
What group of patients have a lower incidence of differentiated thyroid cancer
Afro-americans
What does differentiated thyroid cancer have a strong association with
Exposure to radiation
Diet, other malignancies, family history and smoking can all have an association with the risk of developing differentiated thyroid cancer. True or False
False
What do most patients present with
Palpable nodules in the neck
What is the most common histological type of thyroid cancer
Papillary
How does papillary thyroid cancer tend to spread
Via lymphatics
What is the 10 year survival of papillary thyroid cancer
97%
What is the second most common histological type of thyroid carcinoma
Follicular carcinoma
Where is there a slightly higher incidence of follicular carcinoma
In regions of relative iodine fediciency
How does follicular carcinoma tend to spread
Haematogenously
What is the usual investigation for thyroid cancer
Ultrasound guided Fine needle aspiration of the lesion
What are some clinical predictors of malignancy
New thyroid nodule in patients under 20 or over 50 Males Increasing size >4cm lesion History of head and neck irradiation Vocal cord palsy
What is the treatment of choice for differentiated thyroid cancer
Surgery
What are the surgical options for thyroid cancer
Thyroid lobectomy
Sub-ttoal thyroiectomy
Total thyroidectomy
What is the best surgical option for thyroid cancer
Sub-total thyroidectomy
What patients are AMES high risk
Those with distant metastases
What are the post-operative management plans for thyroid cancer patients
Calcium replacement if required
Patient discharged on T3 and T4
When is IV calcium required
When the levels fall below 1.8
When is whole body iodine scanning used
In patients who have undergone subtotal or total thyroidectomy but who have metastatic thyroid cancer
how is the sensitivity of a whole body iodine scan determined
By ensuring that TSH is elevated
Where is iodine naturally taken up in the body
Salivary glands, the stomach and the bladder (secretion via kidneys)
When is a patient safe to be discharged after thyroid remnant ablation
When the count rate is less than 500cps at 1m
Are patients who are having thyroid remnant ablation allowed patients. Explain
Yes - they must sit diagonally and not be there for too long for their own health
What is a long term effects of TRA
small but significant increase in incidence of AML
