Solitary thyroid nodule
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Solitary thyroid noduleSolitary thyroid nodule
HystoryHystoryLow dose radiationLow dose radiation
Family hystoryFamily hystoryPhysical examPhysical exam
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Diagnostic testDiagnostic test
FNAFNA65%65% BENIGNBENIGN20%SUSPICIOUS20%SUSPICIOUS5%MALIGNANT5%MALIGNANT15%NONDIAGNOSTIC15%NONDIAGNOSTIC1%FULSE POSITIVE1%FULSE POSITIVE3%FULSE NEGATIVE3%FULSE NEGATIVE
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LABORATORY STUDIESLABORATORY STUDIES
EUTHYROIDEUTHYROIDTSHTSHTGTGCALCITONINCALCITONINCEACEA
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IMAGINGIMAGING
SONOGRAPHYSONOGRAPHYCT SCANCT SCANMRIMRITHYROID SCANTHYROID SCAN
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MANABNGEMENTMANABNGEMENT
MALIGNANT THYROIDECTOMYMALIGNANT THYROIDECTOMYCYSTCYST aspirationaspiration
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PAPILARY THYROID CANCERPAPILARY THYROID CANCER
80%80% OF THYROID CA in iodine sufficient OF THYROID CA in iodine sufficient area and children and radiation exposed area and children and radiation exposed
patientspatients female:male ratio 2/1female:male ratio 2/1Age30-40Age30-40EuthyroidEuthyroidLymphatic metastasisLymphatic metastasisMetastasis to long bone liver brainMetastasis to long bone liver brain
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pathologypathology
SectionSectionPsommama bodiesPsommama bodiesMultifocl 85%Multifocl 85%
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Prognostic indicatorPrognostic indicator
95%95% 10years sur10years surPrognostic factorsPrognostic factors AgeAgeHystologic gradeHystologic gradeTumor sizeTumor sizeDifferentiationDifferentiationExternal thyroid invation& metastasisExternal thyroid invation& metastasis
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Surgical treatmentSurgical treatment
high risk patient = total or near total high risk patient = total or near total thyroidectomythyroidectomy
Minimaly ptc = lobectomy isthmectomyMinimaly ptc = lobectomy isthmectomy
If no angioinvation no mutifocal no positive If no angioinvation no mutifocal no positive marginmargin
In low risk patient type of surgery is cotraversyIn low risk patient type of surgery is cotraversy
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Type of surgery in low riskType of surgery in low risk
Total or near totalTotal or near total
Lobectomy isthmectomyLobectomy isthmectomy
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Follicular carcinomaFollicular carcinoma
10%10% of thyroid cancerof thyroid cancerOften in iodine deficiency areaOften in iodine deficiency areaF:m ratio = 3/1F:m ratio = 3/15050 yearsyears Pain is rarePain is rareLymphadenopathy is rare5%Lymphadenopathy is rare5%1%1% hot nodulehot nodule
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FNAFNA
In follicular is not diagnosticIn follicular is not diagnostic
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pathologypathology
Vascular and capsular invationVascular and capsular invationMinimally invasive tumorMinimally invasive tumor
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Surgical treatment &prognosisSurgical treatment &prognosis
Minimally invasive=lobectomyMinimally invasive=lobectomy frankely invasive ca =total thyroidectomyfrankely invasive ca =total thyroidectomyPatient with angioinvation=total Patient with angioinvation=total
thyroidectomythyroidectomyNode disectoin if lymph node is + not Node disectoin if lymph node is + not
prophylaxyprophylaxy
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Hurthle cell caHurthle cell ca3%of thyroid ca3%of thyroid caSub type of follicularSub type of follicularFna same as follicularFna same as follicular Multifocal and multy center 30%rai uptake no or lowMultifocal and multy center 30%rai uptake no or low Local lymph node 30% treatment same as ftc hurthle Local lymph node 30% treatment same as ftc hurthle
cell adenma=lobectomy hurthle cellca total cell adenma=lobectomy hurthle cellca total thyroidectomythyroidectomy
Same as mtc routine central node disectionSame as mtc routine central node disectionLateral node+=MNDLateral node+=MNDRAI scan and ablation not effectiveRAI scan and ablation not effective
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Post opperative manangment of Post opperative manangment of differentiated thyroid cadifferentiated thyroid ca
Thyroid hormoneThyroid hormone
TGTGSONO CT MRI of neck must be done in SONO CT MRI of neck must be done in
high risk patienthigh risk patientRadioiodine therapyRadioiodine therapyExternal beam radiotherapy& chemotherapyExternal beam radiotherapy& chemotherapy
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Medullary thyroid cancerMedullary thyroid cancer5%5% of thyroid caof thyroid caC-cellC-cellMTC is often sporadically 25% is familialMTC is often sporadically 25% is familial15-20%15-20% lymphadenopathy at the time of diagnosislymphadenopathy at the time of diagnosisPain is commonPain is commonDysphagea and dysnea and dysphonea may beDysphagea and dysnea and dysphonea may beMetastas to liver bone(osteoblastic) lungMetastas to liver bone(osteoblastic) lungMMf:m ratio1/1/2f:m ratio1/1/25050——6o6oCalcitonin cea serotonin pr e2 f2alfaCalcitonin cea serotonin pr e2 f2alfa
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MTCMTC
DIARHEADIARHEACushing.s syn ectopic ACTHCushing.s syn ectopic ACTH
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PATHOLOGYPATHOLOGY
IN SPORADIC 80%UNILATERALIN SPORADIC 80%UNILATERAL IN FAMILIAL TYPE 90%BILATERAL IN FAMILIAL TYPE 90%BILATERAL
AND MULTICENTERALAND MULTICENTERALAMYLOID IS DIAGNOSTICAMYLOID IS DIAGNOSTIC
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DIAGNOSISDIAGNOSIS
HYSTORYHYSTORYPHYSICAL EXAMEPHYSICAL EXAMESERUM CALCITONIN AND CEASERUM CALCITONIN AND CEAFNAFNA
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TREATMENTTREATMENT
Gold standard therapy is total thyroidectomy Gold standard therapy is total thyroidectomy if may be becouseif may be becouse
Bilateral central neck node disectionBilateral central neck node disectionMND in node positive and tumor greater thanMND in node positive and tumor greater than 1/51/5 cmcmExternal radiotherapy is debate residual External radiotherapy is debate residual
tumor unresectable recurencetumor unresectable recurenceRF or radiofrequencyRF or radiofrequency
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Anaplastic caAnaplastic ca
1%1%WomenWomen70-8070-80Rapidly enlarge neck massRapidly enlarge neck massDysnea dysphonea dysphagea are commonDysnea dysphonea dysphagea are commonFixed may be ulcerated often lymph node Fixed may be ulcerated often lymph node
possitivepossitive
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Diagnosis and treatmentDiagnosis and treatment
FNA occasionally incisional biopsyFNA occasionally incisional biopsy Poor prognosisPoor prognosis
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limphomalimphoma
Non-hdgkin b-cell typeNon-hdgkin b-cell typeMost commonly from chronic lymphocytic Most commonly from chronic lymphocytic
thyroiditisthyroiditis
Symptom same anaplastic caSymptom same anaplastic ca
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diagnosisdiagnosis
Often with FNAOften with FNANeedle core biopsy or open biopsy may be Needle core biopsy or open biopsy may be
neededneeded
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treatmenttreatment
ChemothrapyChemothrapy RadiotherapyRadiotherapythyroidectomythyroidectomy
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Metastatic caMetastatic ca
Is rareIs rareKidneyKidneyBreastBreastLungLungmelanomamelanoma
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Complication of thyroid surgeryComplication of thyroid surgeryRLN INJERYRLN INJERY EXTERNAL BERANCH OF SUP LARING N EXTERNAL BERANCH OF SUP LARING N
INJERYINJERYNECK SYMPATHETIC NERVE INJURYNECK SYMPATHETIC NERVE INJURYHYPOCALCEMIA AND HYPOCALCEMIA AND
HYPOPARATHYROIDISMHYPOPARATHYROIDISMHEMATOMA HEMORHAGEHEMATOMA HEMORHAGESEROMASEROMACELULITIS INFECTIONCELULITIS INFECTIONJUGULAR VEIN AND CAROTID AND JUGULAR VEIN AND CAROTID AND
ESOPHGUSE INJERY IS RAREESOPHGUSE INJERY IS RARE
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