Thyroid Neoplasms

Question 1

What cell types found in the thyroid gland can neoplasms arise in?

Answer 1

• Vascular elements
• Stromal
• Thyroid follicular cells
• Lymphocytes
• Calcitonin-producing C cells

Question 2

What is the name of the benign thyroid neoplasms?

Answer 2

Adenomas (Follicular Epithelial Cell Adenomas)

Question 3

What is the name of the malignant thyroid neoplasms?

Answer 3

Carcinomas of the follicular epithelium

Question 4

What are the 3 types of carcinomas of the follicular epithelium

Answer 4

• Papillary Thyroid Cancer (PTC)
• Follicular Thyroid Cancer (FTC)
• Anaplastic Thyroid Cancer (ATC)

Question 5

What are some clinical features of Papillary Thyroid Cancer (PTC)?

Answer 5

• Least Aggressive (and MC)
• Slow growing
• Spreads by Lymphatic & Local Extension
• Often Curable
• Good Prognosis

Question 6

What are some clinical features of Follicular Thyroid Cancer (FTC)?

Answer 6

• More common in iodine-deficient areas of the world
• Difficult to dx w/ FNA
• Often Metastasized to Lung, Bone, Brain, Liver
• Often Curable
• Good to Poor Prognosis

Question 7

What are some clinical features of Anaplastic Thyroid Cancer (ATC)?

Answer 7

• Most aggressive
• Very rare
• Seen in Elderly
• Often Causes Dysphagia or Vocal Cord Paralysis
• Responds Poorly to Treatment
• Rapidly Fatal

Question 8

What are poor prognosis features seen in a pt with Follicular Thyroid Cancer (FTC)?

Answer 8

• Distant metastasis
• Age > 50
• Primary tumor size >4cm
• Presence of marked vascular invasion

Question 9

Is thyroid cancer seen in more men or women?

Answer 9

• Women > Man (3:1)

Question 10

What is the age range in men with thyroid cancer? And is the prognosis better or worse?

Answer 10

• Age <20 or > 45

- Larger nodule sized is Worse Prognosis

Question 11

What are some risk factors for thyroid cancer?

Answer 11

• Hx of head and neck irradiation
• Age: <20 or >45
• Vocal cord paralysis, hoarse voice
• Nodule fixed to adjacent structures
• Extrathyroidal extension
• Suspected lymph node involvement
• Family hx
• Bilateral dx
• Increased nodule size >4cm
• New or growing neck mass
• Male gender
• Iodine deficiency (follicular cancer)

Question 12

What is the clinical presentation of thyroid cancer?

Answer 12

• Dysphagia
• Hoarseness
• Neck Pain
• Noticeable enlargement of thyroid gland
• Palpable nodule or asymmetry

Question 13

What are some thyroid cancer treatment options?

Answer 13

• Surgery: for all types
• TSH Suppression Therapy: because most tumors are still TSH-responsive, levothyroxine suppression of TSH is a mainstay of cancer treatment
• Radioiodine Treatment: Post-op radioablation of any remnant thyroid eliminates residual