Differentiated Thyroid Cancer

Question 1

What does differentiated thyroid cancer ever to

Answer 1

Papillary and follicular variants with regards to histological and physiological appearances

Question 2

What do most differentiated thyroid cancers do

Answer 2

Take up iodine and secrete thyroglobulin

Question 3

What drives differentiated thyroid cancer

Answer 3

TSH

Question 4

What does differentiated mean for the patients sake

Answer 4

Good prognosis compared to other solid tumours

Question 5

What does differentiated mean for the clinicians view

Answer 5

The cancerous cells look very similar to normal thyroid cancer cells

Question 6

Describe the incidence and prevalence of differentiated thyroid cancer in women

Answer 6

Rates increase from 15-40 years then plateau

Question 7

Describe the incidence and prevalence of differentiated thyroid cancer in men

Answer 7

Steady increase with age

Question 8

What group of patients have a lower incidence of differentiated thyroid cancer

Answer 8

Afro-americans

Question 9

What does differentiated thyroid cancer have a strong association with

Answer 9

Exposure to radiation

Question 10

Diet, other malignancies, family history and smoking can all have an association with the risk of developing differentiated thyroid cancer. True or False

Answer 10

False

Question 11

What do most patients present with

Answer 11

Palpable nodules in the neck

Question 12

What is the most common histological type of thyroid cancer

Answer 12

Papillary

Question 13

How does papillary thyroid cancer tend to spread

Answer 13

Via lymphatics

Question 14

What is the 10 year survival of papillary thyroid cancer

Answer 14

97%

Question 15

What is the second most common histological type of thyroid carcinoma

Answer 15

Follicular carcinoma

Question 16

Where is there a slightly higher incidence of follicular carcinoma

Answer 16

In regions of relative iodine fediciency

Question 17

How does follicular carcinoma tend to spread

Answer 17

Haematogenously

Question 18

What is the usual investigation for thyroid cancer

Answer 18

Ultrasound guided Fine needle aspiration of the lesion

Question 19

What are some clinical predictors of malignancy

Answer 19

New thyroid nodule in patients under 20 or over 50 
Males 
Increasing size 
>4cm lesion 
History of head and neck irradiation 
Vocal cord palsy

Question 20

What is the treatment of choice for differentiated thyroid cancer

Answer 20

Surgery

Question 21

What are the surgical options for thyroid cancer

Answer 21

Thyroid lobectomy
Sub-ttoal thyroiectomy
Total thyroidectomy

Question 22

What is the best surgical option for thyroid cancer

Answer 22

Sub-total thyroidectomy

Question 23

What patients are AMES high risk

Answer 23

Those with distant metastases

Question 24

What are the post-operative management plans for thyroid cancer patients

Answer 24

Calcium replacement if required

Patient discharged on T3 and T4

Question 25

When is IV calcium required

Answer 25

When the levels fall below 1.8

Question 26

When is whole body iodine scanning used

Answer 26

In patients who have undergone subtotal or total thyroidectomy but who have metastatic thyroid cancer

Question 27

how is the sensitivity of a whole body iodine scan determined

Answer 27

By ensuring that TSH is elevated

Question 28

Where is iodine naturally taken up in the body

Answer 28

Salivary glands, the stomach and the bladder (secretion via kidneys)

Question 29

When is a patient safe to be discharged after thyroid remnant ablation

Answer 29

When the count rate is less than 500cps at 1m

Question 30

Are patients who are having thyroid remnant ablation allowed patients. Explain

Answer 30

Yes - they must sit diagonally and not be there for too long for their own health

Question 31

What is a long term effects of TRA

Answer 31

small but significant increase in incidence of AML