Wednesday, May 2, 2012

Thyroid CA

Most common : Papillary

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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