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Flashcards in Differentiated thyroid cancer Deck (32):
1

What are they types of differentiated thyroid cancer (DTC)?

Papillary and follicular

2

Which substance drives DTC?

Thyroid stimulating hormone

3

What do DTCs take up and secrete?

Take up: Iodine and secrete: thyroglobulin

4

What are the demographics of DTC?

Commoner in females (risk increases until middle age then plateaus) than males (risk increases with age), uncommon in children, lower incidence in black people

5

What is the epidemiology of DTC?

Strong associations with radiation, weak associations with adenoma, chronic elevation of TSH and increasing number of children

6

How does DTC present?

Palpable nodes
Less commonly local of disseminated metastases

7

What is the commonest type of thyroid cancer?

Papillary (followed by follicular)

8

How does papillary thyroid cancer tend to spread and to where?

Lymphatics to cervical nodes

9

How does follicular thyroid cancer tend to spread and to where?

Haematogenously to brain, bones, liver and brain

10

What pathology is papillary cancer associated with?

Hashimoto's thyroiditis

11

What deficiency is follicular cancer associated with?

Iodine

12

What is the prognosis of DTC?

Very, very good

13

How are suspected DTCs investigated?

Ultrasound guided FNA +/- excision biopsy of lymph nodes

14

How are suspected DTCs investigated if there is vocal cord palsy?

Pre-operative laryngoscopy

15

What are the clinical predictors of DTC cancer?

Nodule aged 50
Male
Increasing size
>4cm diameter
History of irradiation
Vocal cord palsy

16

How is DTC treated?

Surgically - lobectomy + isthmusectomy OR sub-total thyroidectomy OR total thyroidectomy

17

What is the risk scoring system for DTC?

A - age
M - metastases
E - extent of tumour
S - size of tumour

18

When is a lobectomy with isthmusectomy used?

Microcarcinomas (

19

When are sub total or total thyroidectomys used?

Extra-thryoidal spread
Bilateral/multifocal involvement
Distant metastases
Nodal involvement
High risk AMES

20

How is lymph node surgery used in DTC?

Papillary - central compartment clearance with biopsy of lateral nodes
Follicular - central compartment clearance

21

What must be checked following thyroid surgery?

Calcium

22

How is a calcium deficiency treated post-thyroid surgery?

Replacement if calcium below 2 mmol/l
IV replacement if calcium below 1.8 mmol/l

23

What medication must a patient be given following thyroid surgery?

T3 or T4 (commonly T4)

24

When and why is whole body iodine scanning used?

3-6 months after subtotal or total thyroid surgery to check that all the thyroid tissue has been cleared

25

What must be stopped prior to whole body iodine scanning?

T3 - 2 weeks prior
T4 - 4 weeks prior

26

When might a patient undergo thyroid remnant ablation?

If uptake of iodine on a full body iodine scan is more than >0.1% of the ingested dose

27

How is thyroid remnant ablation carried out?

Administration of I-131 with extensive radiation precautions

28

What are the side effects of thyroid remnant ablation?

Sialadenitis (salivary gland inflammation) and/or sore throat

29

What level should TSH and free T4 ideally be below following treatment for DTC?

TSH below 0.1mU/l
Free T4 below 25

30

Which substance can be used as a tumour marker (i.e a marker of recurrence)?

Thyroglobulin

31

What are the long term affects of thyroid remnant ablation?

Small increase in acute myeloid leukemia

32

How can recurrent disease be detected?

Rising thyroglobulin
Imaging (whole body thyroid uptake scan, PET)

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