Rank the types of thyroid cancer from most common to least common.
Papillary (absolutely most common)
Medullary (C cells)
Papillary and follicular thyroid cancers are described as ___.
Differentiated thyroid cancers secrete ___ and take up ___.
secrete thyroglobulin (used as a tumour marker)
take up iodine (so iodine can be used to both investigate and kill the cancer)
Which hormone drives papillary and follicular thyroid cancer?
Differentiated thyroid cancers have a (good / bad) prognosis.
Thyroid cancer is more common in (males / females).
Thyroid cancer is strongly associated with exposure to what?
Thyroid cancer incidence increases following what type of accidents?
e.g Chernobyl, Fukushima
How long does it take for thyroid cancer to develop following nuclear incidents?
4 years - several decades
What is found on thyroid examination in the majority of thyroid cancers?
Thyroid cancer is a chance finding following what procedure?
for say hyperthyroidism secondary to Graves disease
What is the most common type of thyroid cancer?
Papillary thyroid cancer spreads via which system?
Papillary thyroid cancer is associated with what type of thyroiditis?
Follicular thyroid cancer tends to spread how?
How are suspected thyroid cancers investigated?
How is thyroid cancer initially treated?
What are the surgical options for treating thyroid cancer?
Lobectomy (including the isthmus)
Why isn't lobectomy commonly carried out anymore?
Leaves half the thyroid intact, skewing thyroid function tests, drug doses etc.
Depending on the risk calculated following surgery, what treatment is added on for thyroid cancer?
Thyroid remnant ablation (TRA)
Which risk stratification tool is used post-op in thyroid cancer?
Age, Metastases, Extent of primary tumour, Size of primary tumour
The AMES system divides post-op thyroid cancer patients into which two groups?
Low risk (cancer is/was confined to the thyroid)
High risk (spread outwith the thyroid)
Which group of patients receive radioactive iodine treatment post-op?
High risk patients
In which type of cancer would lymph node surgery be considered in addition to surgery and TRA?
because it tends to spread lymphatically
Why can patients become hypocalcaemic following thyroid surgery?
Removal of parathyroid glands
Following thyroid surgery, what drug are patients discharged with?
Calcium / recombinant PTH if parathyroids removed
What test is carried out 3-6 months post-op to detect remnants of thyroid cancer?
Whole body iodine scanning
to check for metabolically active cells, i.e cancer
What needs to be elevated before a patient recieves a whole body iodine scan?
to stimulate the metabolism of the cancer cells so they show up on the scan
How are a patient's TSH levels raised prior to their whole body iodine scan?
Stop taking their thyroxine for 2-4 weeks (produces hypothyroid symptoms)
rhTSH injections (don't need to stop thyroxine, but very expensive)
If thyroid cancer is still active following surgery, what treatment is given to patients?
Thyroid remnant ablation
using radioactive iodine