Thyroid

Question 1

Indication of total thyroidectomy in papillary cell carcinoma

Answer 1

thyroidectomy (any present): • Known distant metastases • Extrathyroidal extension • Tumor >4 cm in diameter • Lateral cervical lymph node metastases or gross central neck lymph node metastases• Poorly differentiated • Consider for prior radiation exposure (category 2B)• Consider for bilateral nodularity

Question 2

RAI not typically recommended (if all present):

Answer 2

RAI not typically recommended (if all present): • Classic papillary thyroid carcinoma (PTC) • Largest primary tumor <2 cm • Intrathyroidal • Unifocal or multifocal (all foci ≤1 cm) • No detectable anti‑Tg antibodies • Postoperative unstimulated Tg <1 ng/mLq • Negative postoperative ultrasound, if doner

Question 3

Classification based on iodine concentration

Answer 3

Usually Concentrate lodine to a Degree That May Be Curative
Papillary thyroid carcinoma
Classic
Follicular variant
Oncocytic variant
Follicular thyroid carcinoma
Classic
Often Do NOT Concentrate lodine to a Degree That Is Curative
Unfavorable variants of papillary thyroid carcinoma
Diffuse sclerosing
Tall cell
Columnar cell
Hobnail
Hurthle cell carcinoma
Rarely concentrate iodine to a degree that is curative
poorly differentiated thyroid: insular
never concentrate
anaplastic
medullary

Question 4

Rarely concentrate iodine

Answer 4

Rarely Concentrate lodine to a Degree That Is Curative Poorly differentiated thyroid carcinoma: insular carcinoma

Question 5

Never Concentrate lodine to a Degree That Is Curative

Answer 5

Anaplastic carcinoma Medullary carcinoma

Question 6

RAI typically recommended in

Answer 6

RAI typically recommended (if any present): • Gross extrathyroidal extensiont • Primary tumor >4 cm • Postoperative unstimulated Tg >10 ng/mLq,u Bulky or >5 positive lymph nodes

Question 7

Risk factors for thyroid carcinoma

Answer 7

Radiation exposureReduced iodine uptakeGenetic factors: MEN

Question 8

Disease mentioned by MEN 1, 2a,2b

Answer 8

MEN 1: pituitary adenoma, parathyroid, pancreaticMEN2: parathyroid, phaechromocytoma, medullaryMEN 2b: phaechromocytoma, medullary, mucosal neuromas

Question 9

Indications for total thyroidectomy or lobectomy, if all criteria present?

Answer 9

:• No prior radiation exposure• No distant metastases• No lateral cervical lymph nodemetastases• No extrathyroidal extension • Tumor 1–4 cm in diameter

Question 10

N1a level means

Answer 10

N1a Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral disease

Question 11

N1b

Answer 11

N1b Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes

Question 12

RAI - I3 I dose

Answer 12

30mci= all other cases150mci= pt3b, >_4Ln, ene that is not extensive, positive margin and tag>_1.0 200meli = PTA4) extensive one,m1

Question 13

prognosis of medullary thyroid carcinoma

Answer 13

75% have 5 year survival: local25% 5 year survival if metastatic

Question 14

anaplastic prognosis

Answer 14

1% of thyroid cancer, 1 year survival 20% and median survival 5 months

Question 15

Prgognostic MACIS score for thyroid cancer in differentiated

Answer 15

M: metastatisA-ageC- completeness of resectionI: invasionS=sizepoint: Age 39 yrs: 3.1age >-40 3.1x.08tumor size: size in cm x 3R1/R2: 1locally invasive 1DM: 3

Question 16

MACIS score

Answer 16

low risk <6intermediate risk 6-6.99high risk: 7-7.99

Question 17

prognostic factors for medullary thyroid cancer

Answer 17

host related: age <40gender -male(poor)tumor related:stagevascular invasionCEA levelcalcitonin doubling time( 6-12 months, good)RET mutation, MEN2B

Question 18

which mutation have to be screened for medullary carcinoma

Answer 18

RET proto oncogene

Question 19

classification of thyroid cancer by cell of origin

Answer 19

follicular epithelial cell
well differentiated thyroid cancer
papillary thyroid cancer
classic
follicular variant
oncocytic
unfavorable
-diffuse sclerosing
-tall cell
-columnar cell
-hobnail
follicular thyroid carcinoma
classic
hurthle cell
poorly differentiated
insular
undifferentiated thyroid
anaplastic
parafollicular
–medullary

Question 20

Survival rate of different thyroid cancer

Answer 20

papillary: 80-90% of thyroid cancer. 95% 10yr OS
follicular
85% 10 yr OS
hurthle cell
75% 10yr OS
medullary
2% of thyroid. 75% 5 yr survival
anaplastic
20% 1 yr survival

Question 21

Thyroid radiation dose

Answer 21

WDTC or medullary cancer
60 Gy in 30 daily fractions given in 6 weeks to PTV60.
66 Gy in 33 daily fractions given in 6 1⁄2 weeks to PTV66 if defined.
Anaplastic cancer
20 Gy in 5 daily fractions of 4 Gy given in 7 days.
30 Gy in 6 fractions of 5 Gy given in 2 weeks.
55 Gy in 20 daily fractions of 2.75 Gy given in 4 weeks if high dose treatment.
appropriate (35.75 Gy in 13 fractions to PTV35, 19.25 Gy in 7 fractions to PTV55)