thyroid cancer

Question 1

true or false that you seen hyper/hypothyroidism in thyroid cancer?

Answer 1

false

Features of hyperthyroidism or hypothyroidism are not commonly seen in patients with thyroid malignancies as they rarely secrete thyroid hormones

Question 2

which type of thyroid cancer secretes calcitonin?

Answer 2

medullary

Question 3

what are the 4 main types of thyroid cancer?

Answer 3

• papillary
• follicular
• anaplastic
• medullary

Question 4

which type of thyroid cancer is most common?

Answer 4

papillary

Question 5

what are the risk factors for thyroid cancer?

Answer 5

Female
Head and neck irradiation
Family history

Multiple-endocrine neoplasia type 2 (MEN-2)
MEN-2A: medullary carcinoma of the thyroid, parathyroid hyperplasia (hyperparathyroidism), phaeochromocytoma
MEN-2B: medullary carcinoma of the thyroid, phaeochromocytoma, mucosal neuromas, marfanoid habitus

Question 6

how do patients with thyroid cancer usually present?

Answer 6

• painless neck lump
• no changes to thyroid hormone
• may cause hoarseness if involve the recurrent laryngeal nerve
• dyspnoea if presses on the trachea
• cervical lymphadenopathy-> indicates metastasis to te lymph nodes

Question 7

what are the primary investigations when suspecting a thyroid cancer?

Answer 7

• Thyroid function tests: usually normal as most cancers do not affect thyroid function
• Neck ultrasound: first-line imaging to visualise the thyroid and can be highly specific for certain subtypes e.g. papillary
• Fine needle biopsy: the most important investigation to confirm or exclude malignancy and is usually performed under ultrasound guidance

Question 8

which investigations would you consider when suspecting a thyroid cancer?

Answer 8

• CT neck: conducted if concerned about local invasion or retrosternal extension
• Laryngoscopy: to investigate for vocal cord paralysis if hoarseness is present
• Radionucleotide scan:
  Hot (hyperfunctioning) nodules are almost always benign
  Cold (hypofunctioning) nodules are mostly benign but can be malignant
• Serum calcitonin and calcium: raised calcitonin and hypocalcaemia in medullary cancer
• Core biopsy: performed if fine needle biopsy suggests lymphoma, to confirm the diagnosis

Question 9

which thyroid cancer has the worse prognosis?

Answer 9

anaplastic

Question 10

which type of thyroid antibodies are elevated in thyroid cancer?

Answer 10

thyroglobulin antibodies