thyroid cancer mx

Question 1

clinical features - thyroid ca

Answer 1

1. firm, painless thyroid nodules
2. dyspnea
3. dysphagia
4. hoarseness

Question 2

Which lab tests should be carried out?

Answer 2

1. Thyroid function tests
   - TSH/T3/T4
2. Tumor markers
   - Thyroglobulin
   - Calcitonin levels ( medullar thyroid cancer )

Question 3

Which imaging should be done?

Answer 3

1. ultrasound of thyroid gland
   - > 1 cm malignant
2. thyroid scintigraphy -
   - if low uptake - cold nodule - more likely to be malignant

Question 4

Investigation for diagnosis

Answer 4

Fine needle aspiration - if malignancy is suspected based on ultrasond / scintigraphy

Question 5

Describe the ‘Thy scoring system’

Answer 5

Thy 1. non diagnositic / cystic

Thy 2. benign

Thy 3. neoplasm possible

Thy 4. suspicious of malignancy

Thy 5. malignant

Question 6

Mx of ‘well differentiated cancers’

Answer 6

1. surgical management - Hemi/total thyroidectomy
   - depends on size of thyroid tumor
2. Post operative mx : radioiodine therapy to destory remaining thyroid tissue
3. Start ‘Thyroxine’ supplementation

Question 7

Mx of ‘poorly differentiated cancers’

Answer 7

1. total thyroidectomy with adjuvant radiochemotherapy