Thyroid Ca

Question 1

Papillary (70%)

Answer 1

Often young females - excellent prognosis

Lymph node metastases predominate, haematogenous metastases rare

Question 2

Follicular adenoma

Answer 2

Usually present as a single solitary nodule

Malignancy can only be excluded on formal histological assessment

Question 3

Follicular carcinoma

Answer 3

Vascular invasion predominates

Multifocal disease rare

Question 4

Medullary carcinoma (5%)

Answer 4

Ca of parafollicular (C) cells, secrete calcitonin, part of MEN-2

C-cells derived from neural crest and not thyroid tissue.
Serum calcitonin levels often raised
Familial genetic disease accounts for up to 20% of cases
Both lymphatic and haematogenous metastasis are recognised, nodal disease is associated with a very poor prognosis

Question 5

Anaplastic (1%)

Answer 5

Unresponsive to treatment, can cause pressure symptoms

Most common in elderly females
Local invasion is common feature
Tx through resection if possible. Chemo is ineffective.

Question 6

Lymphoma

Answer 6

Rare

Associated with Hashimoto’s

Question 7

Management of Papillary and Follicular Ca

Answer 7

Total thyroidectomy
Followed by radioiodine (I-131) to kill residual cells
Yearly thyroglobulin levels to detect early recurrent disease