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The Endocrine System > Differentiated Thyroid Cancer > Flashcards

Differentiated Thyroid Cancer Flashcards

1
Q

Why can differentiated thyroid cancers be hard to detect?

A
  1. Histologically similar to normal
  2. Physiologically similar to normal
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2
Q

How do differentiated thyroid cancers differ from normal tissue?

A
  1. They secrete thyroglobulin
  2. They take up iodine to a greater extent
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3
Q

Which population of people have a particularly low incidence of differentiated thyroid cancer?

A

Afro-americans

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4
Q

Lifestyle factors such as smoking and obesity increase risk of differentiated thyroid cancer

True or false?

A

False

An individual cannot really predispose themselves to this type of cancer

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5
Q

What can cause a rise in DTC cases?

A

Nuclear incidents

(this will happen around 25 years after the incident)

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6
Q

How do DTCs often present?

A
  1. Palpable nodule in the neck - either part of the thyroid of a lymph node
  2. Pathological fractures
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7
Q

Cervical lymphadenopathy is associated most with which DTC?

A

Papillary thyroid carcinoma

(spreads lymphatically)

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8
Q

Distant metastasis is most associated with which DTC and why?

A

Follicular thyroid carcinoma

(spreads haematogenously)

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9
Q

Which investigations may be used for DTC?

A
  1. USS-FNA
  2. Excision of lymph nodes
  3. Pre-operative laryngography (if there is vocal cord palsy)
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10
Q

What are the three surgical options for DTC treatment?

A
  1. Thyroid lobectomy
  2. Sub-total thyroidectomy
  3. Total thyroidectomy
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11
Q

What is one postive aspect and one negative aspect to thyroid lobectomy?

A

Positive - Less invasive and lower mortality

Negative - Remaining thyroid poses cancer recurrence risk

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12
Q

What does a subtotal thyroidectomy involve?

A

Leaving 5-10% of the thyroid gland present during removal

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13
Q

What is the main issue with total thyroidectomy?

A

Risks post-operative complications

(e.g. recurrent laryngeal nerve palsy)

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14
Q

For high risk patients, which other treatment option may be used in DTC?

A

Radioiodine

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15
Q

Why may hypocalcaemia develop post-operatively for a DTC?

A

Damage or accidental removal of parathyroid glands

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16
Q

In patients who have undergone subtotal or total thyroidectomy, what will be done 3-6 months post op?

A

Whole body iodine scan

17
Q

In order for a whole body iodine scan to show up remaining tumour, or metastasis, which hormone must be high?

A

TSH

(these tumours are TSH driven)

18
Q

How can TSH levels be boosted prior to a whole body iodine scan?

A

Recombinant human TSH (rhTSH) can be given as an injection

19
Q

Why is the use of rhTSH in the patient’s interest?

A

It can be used in conjunction with T3/4

No symptoms of hypothyroidism need be experienced as T3/4 do not need to be stopped this way

20
Q

If differentiated thyroid cancer is found on a whole body iodine scan, what is the next stage in treatment?

A

250x dose (compared to scanning) of RAI is given to destroy cells

The patient is hospitalised in alead lined room

21
Q

What are the main systemic side effects of RAI?

A

No major side effects

Salivary glands and throat may be sore

22
Q

What does the follow up to RAI therapy involve?

A

Supressing TSH <0.1mU/L to minimise recurrence

Thyroxine can aid with this (must be < 25 however)

23
Q

What can be used as a tumour marker in DTC?

A

Thyroglobulin levels

24
Q

What should the thyroglobulin levels be after RAI treatment?

A

They should be undetectable

25
Q

In which patients is thyroglobulin not a useful tumour marker?

A

Patients with a thyroid lobectomy

Haf the thyroid gland remains to produce physiological thyroglobulin which masks any produced by a tumour

26
Q

What is the main risk associated with RAI treatment?

A

Incidence of acute myeloid leukaemia is increased 50%

(1 : 25,000 down to 1 : 13,000)

27
Q

What is the expected prognosis for DTC?

A

Best of all cancer excluding non-melanoma skin cancer

28
Q

Recurrent DTC will likely present within what length of time post-treatment?

A

2 years

29
Q

Why is recurrent DTC not “the end of the world”?

A

It is still very curable

(I-131 scan and RAI treament again)

30
Q

Why is a rising thyroglobulin but negative I-131 whole body scan worrying?

A

Suggests de-differentiated thyroid cancer

This behaves like an anaplastic cancer

31
Q

If there is a rising thyroglobulin but negative I-131 whole body scan, which other diagnostic test may pick up other cancer types?

A

PET scan

32
Q

Which two drugs, not yet licensed, are promising future treatments for DTC?

A
  1. Sorafenib
  2. Lenvatinib

The Endocrine System (35 decks)

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