Thyroid cancer

Question 1

Define Thyroid cancer

Answer 1

Most commonly an asymptomatic thyroid nodule detected via palpation or ultrasound

4 types account for 98% -medullary, papillary, follicular and anapaestic

CARCINOMAS
unlike thyroid nodules-adenoma-FUNCTIONAL

Question 2

Aetiology and risk factors of Thyroid cancer

Answer 2

Genetic mutations are thought to have a big place-
papillary-80% of cancer-well differentiated and tendency towards multi centricity and lymph nodes
Medullary-4%-familial and sporadic-small amount with MEN–tendency towards multi centricity and lymph nodes
Anaplastic–an undifferentiated neoplasm with mitosis and vascular invasion. It usually presents with local encroachment into the recurrent laryngeal nerve and trachea, muscle, and/or oesophagus.

Follicular: accounts for about 10% of thyroid cancers. spreads through direct invasion rather than lymph nodes. Early forms are indolent, whereas widely invasive forms are aggressive, metastasis

Risk factors
Head and neck irradiation
female
FHx 
Age -30-50

Question 3

Epidiemology of Thyroid cancer

Answer 3

Most common endocrinal cancer
Rising over decardes
3 % of all cancers
about 15 in 100 000 per year
80% are asympto and would go unoticed

Question 4

Signs and Sx of thyroid cancer

Answer 4

So often asymptomatic, and the consequences are often due to the size
nearly never functioning nodule + carcinoma

Hoarseness-from laryngeal nerve involve
Dyspnoae-from tracheal pressure
Dysphagia-from oesophageal pressure
Tracheal deviation
Lymphadenopathy (cervical)
Rapid neck swelling in thyroid lymphoma, especially in the setting of Hashimoto's thyroiditis.

Question 5

Investigations of Thyroid cancer

Answer 5

TSH-should be normal (not hyperthyroid)

USS of neck-nodules, can assess number and characteristics

Fine needle biopsy-gold standard and diagnostic test

I23 absorption test-rule out hot nodule