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Flashcards in Differentiated thyroid cancer Deck (21)
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1
Q

What are the histological classifications of thyroid cancer?

A

Papillary
Follicular
Medullary
Anaplastic

2
Q

What do most differentiated thyroid cancers take up, secrete and are driven by?

A

Take up iodine
Secrete thyroglobulin
Driven by TSH

3
Q

How do differentiated thyroid cancers present?

A

Palpable nodule

5% present with a local or disseminated met

4
Q

Where will papillary thyroid cancer spread?

A

Via lymph to lungs, bone, liver and brain

5
Q

What autoimmune disease is papillary thyroid cancer associated with?

A

Hashimotos

6
Q

Where is the incidence of follicular carcinoma higher?

A

Regions of relative iodine deficiency

7
Q

How are thyroid carcinomas investigated?

A

Ultrasound guided FNA
Excision biopsy of lymph node
If vocal cord palsy, do pre-op laryngoscopy

8
Q

What are the clinical predictors of malignancy?

A
New thyroid nodule age 
Male
Nodule increasing in size
Lesion over 4 cm in diameter
History of head and neck irradiation 
Vocal cord palsy
9
Q

How are thyroid cancers treated?

A

Surgery treatment of choice - thyroid lobectomy with isthmusectomy
Sub-total thyroidectomy
Total thyroidectomy

10
Q

What risk stratification is used post op?

A
AMES
Age
Mets
Extent of tumour
Size of tumour
11
Q

Who is AMES low risk?

A
Younger patients (women <50, men <40) with no evidence of mets 
Older patients with intathyroid papillary lesion with no distant mets
12
Q

What are the 20 year survival for AMES low risk?

A

99%

13
Q

Who are AMES high risk?

A

Distant mets
Extra Thyroid disease in those with papillary cancer
Significant capsular invasion with follicular cancer
Primary tumour over 5cm

14
Q

What is the 20 year survival in AMES high risk?

A

61%

15
Q

When is a thyroid lobectomy with isthmusectomy used?

A

Papillary microcarcinoma (<1cm)
Minimally invasive follicular with capsular invasion only
AMES low risk

16
Q

When is a sub-total or total thyroidectomy used?

A
DTC with extra-thyroid spread
Bilateral or multifocal DTC
Distant mets
Nodal involvement
AMES high risk
17
Q

What is the post op care after thyroid surgery?

A

Calcium check within 24 hours
Calcium replacement if calcium falls below 2 mmol/l
IV calcium for levels below 1.8 mmol/l or if symptomatic
Discharged on T3 or T4

18
Q

When is whole body iodine scanning used?

A

Undergone sub-total or total thyriodectomy

3-6mnths post op

19
Q

What is the pharma regime before a whole body iodine scan?

A

T4 stopped 4 weeks prior
T3 stopped 2 weeks prior
TSH greater than 20

20
Q

What is thyroid remnant ablation?

A

Radiation aimed at thyroid

Ablate residual thyroid tissue in order to destroy occult microfoci

21
Q

What can be used as a tumour marker?

A

Thyroglobulin