Papillary: good prognosis, spread to nodes, slow growing, hx of exposure to radiation (head & neck), Tmt: surgery , Give T3, T4 to suppress TSH
Follicular: distant spread (heamatogenous),
Medullary: Associated with familial syndromes e.g MEN 2a & 2b, produce calcitonin
Anaplastic: worst prognosis, no metastases, Focal growth, palliative tmt
A non functioning (normal TSH) thyroid nodule is more likely to be malignant if:
- history of head & neck radiation
- Male gender
- Older person
- lymph nodes present
- cold nodule on thyroid scan
You MUST do a FNA for every euthyroid nodule:
if malignant do surgery,
if benign, do nothing
if follicular, it may be benign or malignant, FNA can't differentiate so treat as malignant- do surgery.
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