Thyroid Cancer Flashcards
Name the 3 main types of malignant thyroid cancer
- Differentiated
- Medullary
- Anaplastic
What is the most common type of thyroid cancer?
What autoimmune condition is it associated with?
Papillary carcinoma (80%)
Hashitomo’s thyroiditis
What type of cancer comes from C-cells?
What would be found elevated in the blood with this type?
Medullary
Calcitonin (helps to reduce blood calcium levels - however calcium levels are still high as tissues become resistant)
What is the form of cancer with the worst prognosis?
Anaplastic/undifferentiated
- v. rare
- aggressive
From what cells does differentiated cancer come from?
They will look and act like normal thyroid cells. T/F?
Follicular cells
True
Follicular carcinoma has a tendency to break through the fibrous capsule that surrounds the thyroid. T/F?
T
What cancer is associated with:
- low dietary iodine
- radiation exposure in early childhood
Low dietary iodine -> follicular
Radiation in early childhood -> papillary
What is the prognosis of thyroid cancer?
V. good - best prognosis after skin cancer
Thyroid cancer will typically present with a solid nodule in the anterior neck. What signs will make it suggestible of something more malignant?
- Hard + immoveable
- > 4cm
- lymph node spread (papillary)
- other signs suggestive of local invasion (e.g. hoarseness, dysponea, cough, dysphagia)
How is it investiagted?
- USS
2. FNA
What system is used in Tayside to decide if a patient is high risk or low risk?
How does this affect the next treatment step?
AMES Age Mets? Extent of primary tumour Size of primary tumour
Low risk = <50 + <4cm
High risk = mets + capsular invasion/extrathyroid disease
Low risk = lobectomy
High risk = thyroidectomy
What is used as a tumour marker post surgery and TRA?
Thyroglobulin
3-6mnth post total/sub-total thyroidectomy surgery what happens to a patient?
Whole body iodine scanning to assess if any mets and see their thyroid remnant
->
TRA (thyroid remnant ablation)
- Destroys the remaining cancer cells that can’t be removed by surgery
Post thyroidectomy what must the patient be maintained on?
levothyroxine
Pre TRA what do we want the TSH levels to be like compared to post TRA?
Why is this?
Pre TRA - high TSH
Post TRA - low TSH
This is because TRA uses high dose iodine so by having high levels of TSH - makes the cancer cells hungry for iodine (as they want to use it to produce T4 etc)
Post TRA don’t want that anymore
