Thyroid Malignancy

Amr Mohammed Abdullah 11110053

Group A (surgery)
Supervisors :
Dr. Osman , Dr. Zoullfaqar , Dr. Junaid

SOEPEL

Definition
Malignant lesions of
the thyroid gland.
Papillary and
follicular are known
as differentiated
carcinomas.
Anaplastic and
medullary are poorly
or undifferentiated
carcinomas.

Epidemiology
Male:female 1:2.
Peak incidence
depends on
histology:
Papillary: young
adults.
Follicular: middle
age.
Anaplastic: elderly.
Medullary: any age.

etiology
Predisposing
factors:
Pre-existing
goitre.
Previous
radiation of the
neck.
Thyroid cancer in
first degree
relative.

Pathology

Spread

Clinical features
Papillary: solitary
thyroid nodule.
Follicular: slowgrowing thyroid mass,
symptoms from
distant metastases.
Anaplastic: rapidly
growing thyroid mass
causing tracheal and
oesophageal
compression.

Clinical features
Medullary:
thyroid lump,
may have:
MEN IIA (medullary
thyroid carcinoma,
phaeochromocytoma,
hyperparathyroidism)
or MEN IIB (medullary
thyroid carcinoma,
phaeochromocytoma,
multiple mucosal
neuromas, Marfanoid
habitus)
or familial medullary
thyroid cancer (FMTC).

Investigations
Ultrasound of the thyroid
gland.
FNAC: may give histological
diagnosis.
Bone scan and radiographs of
bones for secondary deposits.
Calcitonin levels as a marker
for medullary carcinoma.
Serum thyroglobulin is an
excellent tumour marker in
patients who have had total
thyroidectomy and 131I
ablation.

Immunohistochemical
antifollicular
carcinoma
anaplastic
carcinoma
Papillary carcinoma of theof
calcitonin
antibody
stain of
Medullary
(C-cell)
with
oxyphillic
features
thyroid.
the
thyroid
a medullary
carcinoma
of theon
thyroid
complex
(branches
carcinoma
with
pleomorphic
giant
showing
strong stroma.
red
branches)
core
with
amyloid
tumor
cellfibrovascular
nuclei.
structures covered by
positivity.
crowded, overlapping,

Management
Papillary:
Surgery: total thyroidectomy
and removal of involved
lymph nodes.
Adjunctive treatment: 131I
ablation and TSH suppression
(T4 therapy) (TSH production
stimulates papillary tumour
growth).
Prognosis:
no metastases: 97% 5-year
survival.
Metastases:50% 5-year survival.

Management
Follicular
Surgery: thyroid lobectomy
and removal of involved
nodes for tumours <1 cm or
total thyroidectomy and
removal of involved nodes
for tumours >1 cm or if
metastases or local spread
are present.

Adjunctive treatment: TSH

suppression (T4 therapy) for
all tumours.
131I ablation and TSH
suppression for tumours
treated by total
thyroidectomy.

Management
Anaplastic
Surgery: only to relieve
pressure symptoms.
Adjunctive treatment:
neither radiotherapy nor
chemotherapy is effective.
Some response to
doxorubicin cisplatin.
Prognosis: dismal most
patients will be dead within
12 months of diagnosis.

Management
Medullary:
Exclude
phaeochromocytoma before
treating (MEN II).
Surgery: total thyroidectomy
and excision of regional
lymph nodes.
Adjuvant radiotherapy and
chemotherapy ineffective.
Prognosis: overall 85% 5year survival.

Complications of thyroid
surgery
Postoperative bleedingan
expanding haematoma can
cause laryngeal oedema and
airway obstruction.
Rx: relieve haematoma,
intubate.
Voice dysfunction: damage to
recurrent or external laryngeal
nerves (only 1% have
permanent injury and few
require treatment).
Vocal cords should be checked
by laryngoscopy preoperatively.

Complications of thyroid
surgery

Hypocalcaemia damage to
parathyroid glands.
Rx: 500 mg elemental calcium t.d.s.
vitamin D (alfacalcidol or calcitrol).
If severe symptoms give calcium
gluconate IV slowly.
Hypothyroidism (expected
consequence of total
thyroidectomy).
Measure TSH levels and replace with
T4 (or T3).
Thyrotoxic storm: rare now.
May occur during or after surgery for
Graves disease.
Rx: beta-blockade, steroids, iodine
and propylthiouracil.

2-week wait referral criteria for

suspected head and neck cancer
Horseness >6 weeks.
Oral ulceration >3
weeks.
Oral swellings >3
weeks.
Dysphagia >3 weeks.
Neck mass >3 weeks.
Cranial neuropathies.
Rapidly developed
thyroid lump.

References
THE SURGICAL REVIEW An
Integrated Basic and Clinical
Science Study Guide page: 242
The Mont Reid Surgical
Handbook 651
Surgery at a Glance, Fifth
Edition - Grace, Pierce A.,
Borley, Neil R 146

Thank you
All