Thyroid Cancer

Question 1

what is the most common subtype of thyroid cancer?

Answer 1

• papillary thyroid cancer
• typically slow-growing, often found in one lobe of the thyroid gland
• characteristically spreads via lymphatics

Question 2

what is the second most common subtype of thyroid cancer?

Answer 2

• follicular carcinoma
• can sometimes cause a lump or pain in the neck
• typically slower growing than poorly differentiated thyroid cancers

Question 3

what is medullary thyroid carcinoma?

Answer 3

• a cancer of the calcitonin cells associated with multiple endocrine neoplasia type 2A (MEN 2A)
• may also have other features of MEN 2A (e.g. hypertension secondary to a phaeochromocytoma)

Question 4

what is anaplastic thyroid carcinoma?

Answer 4

anaplastic thyroid carcinoma (ATC), also known as undifferentiated thyroid cancer, is a rare and highly aggressive form of thyroid cancer

Question 5

what are the risk factors for thyroid cancer?

Answer 5

• female
• obesity
• benign thyroid disease (e.g. hashimoto’s, thyroid adenoma, goitre)
• radiation
• genetic (e.g. MEN)
• SLE

Question 6

what are the symptoms of thyroid cancer?

Answer 6

• neck lump
• hoarseness
• dysphagia
• odynophagia
• dyspnoea
• stridor

Question 7

when assessing a thyroid nodule, what are the features that increase suspicion of malignancy?

Answer 7

• age <20 or >60
• firmness of nodule
• rapid growth
• fixed to adjacent structures
• vocal cord paralysis
• regional lymphadenopathy
• irradiation of the neck
• family history of thyroid cancer

Question 8

what are the investigations for thyroid cancer?

Answer 8

• TFTs
• autoantibody
• plasma calcitonin (e.g. MEN)
• plasma CEA (e.g. MEN)
• US
• MRI/CT
• FNAC

Question 9

when should a 2-week wait (e.g. urgent suspected cancer) referral be considered for a patient with a thyroid lump?

Answer 9

for an unexplained thyroid lump, especially if they have red flag features:

• unexplained hoarseness or voice changes
• associated lymphadenopathy
• sudden onset of an expanding painless thyroid mass
• any other red flags of malignancy
• compressive symptoms of dysphagia, or breathlessness

Question 10

what are the options for the management of thyroid cancer?

Answer 10

• thyroidectomy
• radioactive remnant ablation (RAA)
• chemoradiotherapy
• immunotherapy
• life-long thyroxine replacement
• calcium replacement (e.g. if the parathyroids have been removed)

Question 11

what is the role of serum thyroglobulin in the monitoring of thyroid cancer?

Answer 11

• serum thyroglobulin is a marker used to monitor for signs of disease recurrence
• this protein is only produced by follicular cells