Thyroid cancer 2

Question 1

Lymph node spread is common at diagnosis so what is done to treat this ?

Answer 1

• Central compartment clearance
• Lateral lymph node sampling is done if its a papillary tumour due to them spreading often by lymphatics

Question 2

When would you do whole body iodine scanning followed by radio-ablation?

Answer 2

In all patients following a sub-total or total thyroidectomy

Question 3

Describe the process of iodine scanning

Answer 3

Radioactive iodine scans check whether there are any thyroid cancer cells in your body. Before a radioactive iodine scan you’ll need to stop taking thyroid hormone replacement tablets.

This is done so that the body will produce enough thyroid-stimulating hormone (TSH) to make the tests as accurate as possible. TSH makes any thyroid cells, or thyroid cancer cells that may be left in your body, produce thyroglobulin and absorb radioactive iodine.

Due to stopping the thyroid hormone replacements you may develop symptoms of hypothyroidism. You can start taking your tablets again once the tests are finished.

Recombinant human thyroid stimulating hormone (rhTSH) It may be possible to be treated with recombinant human TSH (or rhTSH) to overcome the problems of stopping your hormone replacement treatment. This man-made drug (also known as thyrotropin alfa or Thyrogen®) is similar to the TSH produced in your body. If you are given rhTSH you don’t need to stop taking your thyroid hormone replacement tablets, and won’t develop the symptoms of hypothyroidism. You’ll be given two injections, 24 hours apart. You can be given the radioactive iodine the next day if you are having a scan. The scan will then be done 48–72 hours later.

Question 4

What treatment is received after whole body iodine scanning ?

Answer 4

Thyroid remant ablation

Question 5

What are the side effects of thyroid remnant ablation?

Answer 5

Few - but can cause sore throat and sialadenitis (inflammation of salivary gland)

Question 6

What is done after thyroid remant ablation ?

Answer 6

• Discharge on T3 or T4
• Repeat iodine scan in a bit to ensure no cancer cells remain

Question 7

Describe the typical treatment pathway for thyroid cancers

Answer 7

• Surgery - typically sub-total thyroidectomy (leaves 5-10% of gland)
• Central compartment clearance
• The iodine scan
• Then thyroid remnant ablation