Thyroid cancer

Question 1

Name the different types of thyroid cancer

Answer 1

• Papillary
• Follicular
• Medullary
• Anaplastic
• Lymphoma
  Hurthle cell - Grannular

Question 2

Describe features of papillary thyroid cancer

Answer 2

Most common type. Associated with BRAF and RET mutations.
See Psammoma bodies (calcium deposits in papilli)
Typically presents aged 30-40
Can spread locally or metastasis to lung/bone

Question 3

Describe features of follicular thyroid cancer

Answer 3

Second most common. Associated with RAS mutations.
Common in areas of low iodine and women
More likely to metastise than invade locally

Question 4

Describe features of medullar thyroid cancer

Answer 4

Rare.
Associated with RET mutation and often only singular
Can present with hypocalcaemia and diarrhoea because derived from calcitonin producing cells. Associated with MEN 2A/2B

Question 5

What are features of anaplastic thyroid cancer

Answer 5

Extremely aggressive but not common. Often invaded local structures by presentation.

Question 6

Describe features of lymphoma thyroid cancer

Answer 6

Highly associated with Hashimoto’s thyroiditis. Always NHL

Question 7

What is the treatment for papillary/follicular thyroid cancer?

Answer 7

Total thyroidectomy followed by radiotherapy to kill residual cells.

Question 8

Briefly explain thyroid hormone synthesis

Answer 8

Thyroglobulin gets converted into triiodothyroxine (T3) and thyroxine (T4). T3 will stimulate metabolism, cardiac output, bone reabsorption and sympathetic nervous system.

Question 9

What is the function of calcitonin?

Answer 9

Produced by parafollicular cells. Lowers blood calcium levels by inhibiting osteoclasts

Question 10

What is the presentation of thyroid cancer?

Answer 10

Solitary, painless nodule.
Typically hard and immobile.
Can cause hoarsness and dysphagia.

Question 11

What are the investigations for thyroid cancer?

Answer 11

Thyroid ultrasound and FNA,
TFT
Radioiodine scan