thyroid cancer

Question 1

does thyroid cancer cause hyper or hypothyroidsism?

Answer 1

neither!
not common as they rarely secret thyroid hormones

Question 2

types of thyroid cancer

Answer 2

papillary (70%) - young females, good prognosis

follicular (20%)

medullary (5%) - part of MEN2, parafollicular (C) cells

anaplastic (1%)

lymphoma - rare, assoc with hashimotos

Question 3

management of papillary + folicular cancer

Answer 3

total thyroidectomy
- followed by radioiodine to kill residual cells

yearly thyroglobulin levels to detect early recurrent disease

Question 4

medullary carcinoma

Answer 4

cancer of parafollicular (C) cells
- C cells derived from neural crest, not thyroid tissue

• secrete calcitonin
• part of MEN2
• nodal disease = v poor prognosis

Question 5

anaplastic carcinoma

Answer 5

most common in elderly females
- commonly unresponsive to treatment
- can cause pressure symptoms

local invasion common

mx
- resection where possible
- palliation - isthmusectomy + radiotherapy
- chemo = ineffective

Question 6

thyroid surgery complications

Answer 6

• recurrent laryngeal nerve damage
• bleeding - haematomas may rapidly lead to resp compromise owing to larygeal oedema
• damage to parathyroid glands resulting in hypocalcaemia

Question 7

Ix of thyroid nodule

Answer 7

TFTs
Ultrasonaography = 1st line

Question 8

benign causes of thyroid nodules

Answer 8

• multinodular goitre
• thyroid adenoma
• hashimotos
• cysts - colloid, simple or haemorrhagic