THYROID MALIGNANCIES

BIBASWAN CHAKRABARTY
PGT-1 (UNIT 1)
NBMCH
ANATOMY
PHYSIOLOGY
 CLASSIFICATION

• DTC : (differentiated)
1. PTC(papillary) (84%)
2. FTC(follicular) (11%)
3. HTC(hurthle)
• PDTC(poorly differentiated)
• MTC(medullary) (2%)
• ATC(anaplastic) (1%)
• LYMPHOMA, SARCOMA
• SECONDARIES
 RISK FACTORS

• Radiation exposure
• Pre existing multinodular goitre
• Family history
• Genetic
• Hashimotos Thyroiditis
 SPECIFIC TUMOR TYPES

PAPILLARY CARCINOMA:
 84%
 Occurs in iodine sufficient areas
 Predominant thyroid malignancy in children and individuals exposed to
external radiation.
 F:M ----2:1
 Mean age ---- 30-40 yrs
 Presents as in a euthyroid state as slow growing painless mass
 “lateral aberrant thyroid” ---- lymphnode metastasis are common in children
and young adults
 Dysphagis, dyspnea, dysphonia (+) ----- locally advanced invasive disease
 Diagnosis- FNAC ----if (+)  complete neck ultrasound
 Prognosis- >95% 10-year survival rate.
FOLLICULAR CARCINOMA:
 11%
 Predominant in Iodine deficient areas
 F:M----3:1
 Mean age of presentation----50 years
 Common mode of presentation- solitary thyroid nodule with H/O rapid
increase in size and long standing goitre
 Pain is unlikely
 Lymph node metastasis- uncommon
 Distant metastasis may be present
HURTHLE CELL CARCINOMA:
 Approx 3%
 Like follicular, shows capsular and vascular invasion and hence can’t be
diagnosed on FNAC
 They differ from follicular carcinoma as they are more often:
1: multifocal and bilateral
2: usually do not take up RAI
3: more likely to metastasize to local nodes and distant sites
 TREATMENT OF DTC

PAPILLARY CARCINOMA:
 <1 cm tumor without extrathyroidal involvement or lymphy node involvement
Active surveillance  if increase in size- surgery
Thyroid lobectomy

 >1 and <4 – Total or near total thyroidectomy with central neck node dissection
If lateral nodes are palpable, or FNAC proven , or picked up on ultrasonography
then go for modified radical or functional neck dissection
If level 2 , 3, 4 extensively involved then go for posterior triangle and suprahyoid
dissection as well
FOLLICULAR CARCINOMA:
 Total thyroidectomy is recommended if:
>4 cm tumor (+ central node dissection)
Older age group
Positive family history
H/o radiation exposure
Fnac shows atypia
HURTHLE CELL CARCINOMA:
 Total thyroidectomy with routine central neck node dissection
POST OP MANAGEMENT:
 RAI:
CANDIDATES
1. Extrathyroidal involvement
2. Distant metastasis
3. High risk patients
4. >40 years of age
5. Local recurrence
6. Aggressive histologic variants
 THYROID HORMONES
 FOLLOW UP:
Every 6 to 12 monthly with bloog tg and anti Tg levels
Neck ultrasound
• MEDULLARY CARCINOMA:
• 2%
• Arises from parafollicular or C cells
• Usual location – superolaterally (with respect to lobes)
• F:M----1.5 : 1
• 50-60 years
• Most MTCs occur sporadically
• Around 25% are associated with inherited syndromes
• Present with a palpable neck mass with cervical lymphadenopathy(15%-20%)
• Pain- more common
• Dyspnea, dysphagia, dysphonia is more common
ANAPLASTIC CARCINOMA:
 Around 1%
 7th to 8th decades of life
 Women are more affected
 Long standing neck mass with rapid increase in size
 Painful
 Local invasive features present
 Tumor is usually larged fixed to surrounding structures
 May be ulcerated , necrosed
 Palpable lymphadenopathy