Thyroid Cancer

Question 1

Define thyroid cancer

Answer 1

Cancer of the thyroid gland
• Papillary – 80%
- Well differentiated, lymph node involvement
- Psammoma bodies (calcified rings), Orphan Annie eyes (clear nuclei)
• Follicular – 15%
- Hurthle cells (also associated with Hashimoto’s thyroiditis)
- Distant metastases
• Medullary – 5%
- Arises from thyroid parafollicular C cells
- MEN IIA/B
• Anaplastic – rare
- Undifferentiated
• Lymphoma

Question 2

What are the causes/risk factors of thyroid cancer?

Answer 2

• Female
• Radiation
• Family history (MEN IIA/B – medullary thyroid cancer, phaeochromocytoma,
hyperparathyroidism

Question 3

What are the symptoms of thyroid cancer?

Answer 3

• Neck lump
• Hoarseness
• Dyspnoea
• Dysphagia

Question 4

What are the signs of thyroid cancer?

Answer 4

• Tracheal deviation

* Cervical lymphadenopathy

Question 5

What investigations are carried out for thyroid cancer?

Answer 5

• Bloods
- TFTs
- Bone profile
- Thyroid autoantibodies if Hashimoto’s/Graves’s suspected
- Tumour Markers
> Thyroglobulin - papillary and follicular
> Calcitonin - medullary
• CXR with thoracic inlet: tracheal goitres and metastases?
• USS
• Radionuclide scan: malignant lesions show as hypofunctioning (cold) whereas a hyperfunctioning hot lesion suggests adenoma
• Fine-Needle Aspiration Cytology (FNA) - allows histological diagnosis
• Excision Lymph Node Biopsy - if there is cervical lymphadenopathy
• CT/MRI - for staging