Papillary Thyroid Cancer

Question 1

Genes

Answer 1

Mc gene
Glial derived neurotropic factor(GDNF)
RET/PTC mutations

Question 2

Diagnosis

Answer 2

Fine needle aspiration cytology

Psammoma bodies
Orphan annie eye nuclei
Nuclear grooving

Question 3

Hemithyroidectomy

Answer 3

<40-45 yrs
<2cm
Unifocal
No lymphovascular invasion
No distant metastasis

Question 4

Otherwise

Answer 4

Total thyroidectomy

Question 5

Level 6 lymph node

Answer 5

Total thyroidectomy+central neck dissection

Question 6

Level 6+ other node

Answer 6

TT+CND+modidied radical neck dissection

Question 7

Prophylactic level 6 clearance before thyroid surgery should be done in the presence of

Answer 7

T3 T4 tumour

Question 8

Identify residual or metastatic disease of PTC

Answer 8

Whole body iodine scan

Question 9

Requirements for iodine scan

Answer 9

TSH>20

Question 10

Conventional preparation for iodine scan

Answer 10

Don’t give thryroxine for 4-6 weeks

Question 11

Newer meathod for iodine scan preparation

Answer 11

Recombinant TSH injection

2 injec
2 days

Question 12

What to do when Residual disease present after PTC treatment

Answer 12

Radioidoine abalation
50-100 millicuries

Question 13

Indications for single dose of radioiodine abalation

Answer 13

Positive lymph nodes
Extracapsular spread
Residual disease
Metastasis
Persistently high Thyroglobulin

Question 14

No residual disease

Answer 14

Follow up

6 monthly-usg neck, serum tg

Question 15

When to suspect recurrence

Answer 15

Serum tg >2ng/ml

Question 16

Tumour marker for DTC

Answer 16

Thyroglobin

Question 17

Thyroglobin is not a reliable marker in

Answer 17

Hashimoto thtroiditis(anti thyroid antibody)

Question 18

Treatment for Tumour resistant to radio iodine abalation

Answer 18

External beam radio therapy

Question 19

Follicular variant of paipillary tumour

Answer 19

Lindsey tumour