Thyroid cancer

Question 1

differentiated thyroid cancers

Answer 1

meaning good prognosis compared to other solid tumours
refers to histiological appearance but also physiological characteristcs
refers to a group of cancers that arise from follicular cells

Question 2

subtypes of DTC

Answer 2

papillary thyroid carcinoma
follicular thyroid carcinoma

Question 3

papillary thyroid cancer charcateristcs

Answer 3

slow growing and often spreads to lymph nodes
more comon type
Assoc with hashmitotos
Assoc with ionising radiation

Question 4

which is associated with hashimotos

Answer 4

papillary thyroid carcinoma

Question 5

which type is more haematoligically spread

Answer 5

follicular thyroid carcinoma

Question 6

follicular thyroid carcinoma characteristcs

Answer 6

Second commonest

incidence higher in iodine deficiency places

Spreads haematogenously

Higher incidence in females

presents later in life

Question 7

epidemiology of DCT

Answer 7

Uncommon In children
Males steady increase
Females rates increase 15-40 then plateau

Question 8

Investigations in DCT

Answer 8

best being us
can involve excision biopsy of lymph node- fine needle aspiration for cytology

Question 9

predictors of malignancy

Answer 9

• New nodule <20 or >50
  
  • Male
  • Increasing in size
    >4cm

Question 10

most common treatment

Answer 10

surgery

Question 11

presentation

Answer 11

• Palpable nodules
  
  • Chance findings on histological tissue
    Local or disseminated metastases; hoarseness, dysphagia, cough- suggest advanced disease

Question 12

post op care

Answer 12

• Calcium checked within 24hrs
  ○ Replacement if coreected calcium falls below 2mmol
  ○ Iv calcium for levels below 1.8/ symptomatic

Patient discharged on t3 or t4

Question 13

what does whole body iodine scanning detect

Answer 13

thyroid tissue to see if recurrence of thyroid cancer in body after thyroid removed

Question 14

who is iodine scanning performed in

Answer 14

Used in patients who have undergone sub total or total thyroidectomy ; 3-6 months post op

Question 15

what is stopped prior to iodine scanning

Answer 15

○ T4 stopped 4 weeks prior to scan
T3 stopped 2 weeks prior

Question 16

thyroid remnant ablation

Answer 16

Aimed at eliminating any residual thyroid tissue following thyroidectomy

Question 17

what mustnt you be for thyroid remnant ablation to be performed

Answer 17

pregnant

Question 18

follow up after thyroid remnant ablation

Answer 18

• Patients maintained on t4
  Aim to suppress tsh to <0.1 and have ft4 below 25

Question 19

how is recurrent disease detected

Answer 19

by rising tg or by imaging

Question 20

what is recurrence in cervical lymph nodes more common in

Answer 20

papillary thyroid carcinoma

Question 21

what is haematognous spread recurrence more common in

Answer 21

follicular thyroid carcinoma

Question 22

follow up care

Answer 22

In both the low and high risk groups, measure TSH and Tg every 6 months for first 5 years, then annually for next 5 years

To minimise risk of recurrence patients are treated with suppressive doses of levothroxane

Question 23

what is thyroglobulin a protein precurosr of

Answer 23

t4/t3
so can be used as a tumour marker

Question 24

medullary thyroid cancer

Answer 24

cancer of the parafollicular cells and so secrete calcitonin

Question 25

what investigation to screen for disease recurrence in medullary cancer

Answer 25

serum calcitonin