Thyroid Cancer

Question 1

Definition

Answer 1

Malignancy arising in the thyroid gland

Question 2

Types

Answer 2

o Papillary
o Follicular
o Medullary
o Anaplastic

Question 3

Aetiology

Answer 3

Unknown

Question 4

Risk factors

Answer 4

o Childhood exposure to radiation
o Medullary thyroid cancers may be familial and are associated with MEN IIa or IIb
o Lymphoma is associated with Hashimoto’s thyroiditis

Question 5

Epidemiology

Answer 5

· RARE
· More common in FEMALES

· Papillary: 20-40 yrs
· Follicular: 40-50 yrs
· Anaplastic: more common in the ELDERLY

Question 6

Presenting symptoms

Answer 6

· Slow-growing neck lump
· Discomfort swallowing
· Hoarse voice

Question 7

Signs on physical examination

Answer 7

· Palpable nodules or diffuse enlargement of thyroid gland

· Cervical lymphadenopathy –> suspect malignancy

· NOTE: the patient is usually euthyroid

Question 8

Investigations (bloods)

Answer 8

o TFTs

o Bone profile

o Tumour Markers
· Thyroglobulin - papillary and follicular
· Calcitonin - medullary

Question 9

Investigations (other)

Answer 9

· Fine-Needle Aspiration Cytology (FNA)
o Allows histological diagnosis

· Excision Lymph Node Biopsy
o If there is cervical lymphadenopathy

· Isotope Scan
o If the cause of the thyroid lump is unclear

· CT/MRI - for staging