Solitary thyroid nodule

1. Solitary thyroid nodule Hystory Low dose radiation Family hystory Physical exam

2. Diagnostic test • FNA • 65% BENIGN • 20%SUSPICIOUS • 5%MALIGNANT • 15%NONDIAGNOSTIC • 1%FULSE POSITIVE • 3%FULSE NEGATIVE

3. LABORATORY STUDIES • EUTHYROID • TSH • TG • CALCITONIN • CEA

4. IMAGING • SONOGRAPHY • CT SCAN • MRI • THYROID SCAN

5. MANABNGEMENT • MALIGNANT THYROIDECTOMY • CYST

6. PAPILARY THYROID CANCER • 80% OF THYROID CA in iodine sufficient area and children and radiation exposed patients • female:male ratio 2/1 • Age30-40 • Euthyroid • Lymphatic metastasis • Metastasis to long bone liver brain

7. pathology • Section • Psommama bodies • Multifocl 85%

8. Prognostic indicator • 95% 10years sur • Prognostic factors • Age • Hystologic grade • Tumor size • Differentiation • External thyroid invation& metastasis

9. Surgical treatment • high risk patient = total or near total thyroidectomy • Minimaly ptc = lobectomy isthmectomy If no angioinvation no mutifocal no positive margin In low risk patient type of surgery is cotraversy

11. Type of surgery in low risk • Total or near total • Lobectomy isthmectomy

12. Follicular carcinoma • 10% of thyroid cancer • Often in iodine deficiency area • F:m ratio = 3/1 • 50 years • Pain is rare • Lymphadenopathy is rare5% • 1% hot nodule

13. FNA • In follicular is not diagnostic

14. pathology • Vascular and capsular invation • Minimally invasive tumor

15. Surgical treatment &prognosis • Minimally invasive=lobectomy • frankely invasive ca =total thyroidectomy • Patient with angioinvation=total thyroidectomy • Node disectoin if lymph node is + not prophylaxy

16. Hurthle cell ca • 3%of thyroid ca • Sub type of follicular • Fna same as follicular • Multifocal and multy center 30%rai uptake no or low • Local lymph node 30% treatment same as ftc hurthle cell adenma=lobectomy hurthle cellca total thyroidectomy • Same asmtc routine central node disection • Lateral node+=MND • RAI scan and ablation not effective

17. Post opperative manangment of differentiated thyroid ca • Thyroid hormone • TG • SONO CT MRI of neck must be done in high risk patient • Radioiodine therapy • External beam radiotherapy& chemotherapy

18. Medullary thyroid cancer • 5% of thyroid ca • C-cell • MTC is often sporadically 25% is familial • 15-20% lymphadenopathy at the time of diagnosis • Pain is common • Dysphagea and dysnea and dysphonea may be • Metastas to liver bone(osteoblastic) lung • M • f:m ratio1/1/2 • 50—6o • Calcitonin cea serotonin pr e2 f2alfa

19. MTC • DIARHEA • Cushing.s syn ectopic ACTH

20. PATHOLOGY • IN SPORADIC 80%UNILATERAL • INFAMILIAL TYPE 90%BILATERAL AND MULTICENTERAL • AMYLOID IS DIAGNOSTIC

21. DIAGNOSIS • HYSTORY • PHYSICAL EXAME • SERUM CALCITONIN AND CEA • FNA

23. TREATMENT • Gold standard therapy is total thyroidectomy if may be becouse • Bilateral central neck node disection • MND in node positive and tumor greater than • 1/5 cm • External radiotherapy is debate residual tumor unresectable recurence • RF or radiofrequency

24. Anaplastic ca • 1% • Women • 70-80 • Rapidly enlarge neck mass • Dysnea dysphonea dysphagea are common • Fixed may be ulcerated often lymph node possitive

25. Diagnosis and treatment • FNA occasionally incisional biopsy • Poor prognosis

26. limphoma • Non-hdgkin b-cell type • Most commonly from chronic lymphocytic thyroiditis Symptom same anaplastic ca

27. diagnosis • Often with FNA • Needle core biopsy or open biopsy may be needed

28. treatment • Chemothrapy • Radiotherapy • thyroidectomy

29. Metastatic ca • Is rare • Kidney • Breast • Lung • melanoma

30. Complication of thyroid surgery • RLN INJERY • EXTERNAL BERANCH OF SUP LARING N INJERY • NECK SYMPATHETIC NERVE INJURY • HYPOCALCEMIA AND HYPOPARATHYROIDISM • HEMATOMA HEMORHAGE • SEROMA • CELULITIS INFECTION • JUGULAR VEIN AND CAROTID AND ESOPHGUSE INJERY IS RARE

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