Thyroid cancer

Question 1

Define:

Answer 1

Malignancy arising in the thyroid gland:

Types:

• Papillary (60%)
• Follicular (25%)
• Medullary (5%)
• Lymphoma (5%)
• Anaplastic (rare)

Question 2

Aetiology:

Answer 2

Unknown

Question 3

Risk factors:

Answer 3

Medullary thyroid cancer

MEN IIa and IIb

Lymphoma due to Hashimoto’s

Question 4

Epidemiology:

Answer 4

Rare

More common in females

Papillary in 20-40 years

Follicular in 40-50 years

Question 5

Symptoms:

Answer 5

Slow growing neck lump

Discomfort swallowing

Hoarse voice

Question 6

Signs:

Answer 6

Palpable nodules and diffuse enlargement

Cervical lymphadenopathy

Usually euthyroid

Question 7

Investigations:

Answer 7

Bloods:

• TFTs
• Bone profile
• Thyroid autoantibodies if Hashimoto’s/Graves’s suspected

Tumour Markers
• Thyroglobulin - papillary and follicular
• Calcitonin - medullary

CXR with thoracic inlet: tracheal goitres and metastases?

USS

Radionuclide scan: malignant lesions show as hypofunctioning (cold) whereas a hyperfunctioning hot lesion suggests adenoma

Fine-Needle Aspiration Cytology (FNA)
o Allows histological diagnosis

Excision Lymph Node Biopsy
o If there is cervical lymphadenopathy

CT/MRI - for staging