Answers:
A 55 year old patient with a single 1.9cm thyroid nodule found to be papillary carcinoma on FNA with no evidence of LN involvement should receive what treatment?
A) Lobectomy and modified neck dissection with postop L-thyroxine, no surveillance needed
B)Total thyroidectomy and modified neck dissection with postop Lthyroxine and long term surveillance
C) Total thyroidectomy with postop Lthyroxine, no surveillance needed
D) Total thyroidectomy with postop Lthyroxine and longterm surveillance
E) Total thyroidectomy with postop ablation, Lthyroxine and long term surveillance
For patients with lesions >1cm, age>45 or multicentric/invasive lesions treatment involves total thyroidectomy. If there is evidence of LN spread then modified neck dissection is warranted. Postop, ablation should be performed, treatment with L-thyroxine should be started and long term surveillance should be carried out. If the patient is less than 45 with a <1cm lesion and no evidence of extrathyroidal spread then lobectomy or total thyroidectomy is warranted with postop L-thyroxine but no ablation or long term surveillance.
Why is it difficult to r/o follicular carcinoma on FNA?
The difference between follicular adenoma and follicular carcinoma is that follicular carcinoma demonstrates pericapsular/vascular invasion. As it is possible to obtain an FNA from a follicular carcinoma that does not incorporate the capsule and thus cannot r/o invasion into it, it is difficult to tell these two pathologies apart.
MC Questions:
All of the following are risk factors for papillary carcinoma except...
A) Lobectomy and modified neck dissection with postop L-thyroxine, no surveillance needed
B)Total thyroidectomy and modified neck dissection with postop Lthyroxine and long term surveillance
C) Total thyroidectomy with postop Lthyroxine, no surveillance needed
D) Total thyroidectomy with postop Lthyroxine and longterm surveillance
E) Total thyroidectomy with postop ablation, Lthyroxine and long term surveillance
For patients with lesions >1cm, age>45 or multicentric/invasive lesions treatment involves total thyroidectomy. If there is evidence of LN spread then modified neck dissection is warranted. Postop, ablation should be performed, treatment with L-thyroxine should be started and long term surveillance should be carried out. If the patient is less than 45 with a <1cm lesion and no evidence of extrathyroidal spread then lobectomy or total thyroidectomy is warranted with postop L-thyroxine but no ablation or long term surveillance.
Why is it difficult to r/o follicular carcinoma on FNA?
The difference between follicular adenoma and follicular carcinoma is that follicular carcinoma demonstrates pericapsular/vascular invasion. As it is possible to obtain an FNA from a follicular carcinoma that does not incorporate the capsule and thus cannot r/o invasion into it, it is difficult to tell these two pathologies apart.
MC Questions:
All of the following are risk factors for papillary carcinoma except...
A)Radiation exposure
B)Hashimoto's
C) Cowden Syndrome
D) FAP
E) None of the above are risk factors
Free Response Question:
What are the four main types of thyroid cancer?
Quick Facts:
Follicular Carcinoma
-2nd most common thyroid cancer (16%)
Clinical Findings
-Histo = small follicles w/ small, cuboidal cells and poor colloid formation.
-Carcinoma has capsule/vascular invasion whereas adenoma does not. FNA hard to do this so get frozen section @ surgery.
-Can synthesize thyroglobulin and concentrates iodine (thus radioactive iodine treatment works)
-Slightly more aggressive than papillary CA.
-Hurthle cell and poorly differentiated subtypes don't take up radioiodine and have higher mets/recurrence.
B)Hashimoto's
C) Cowden Syndrome
D) FAP
E) None of the above are risk factors
Free Response Question:
What are the four main types of thyroid cancer?
Quick Facts:
Follicular Carcinoma
-2nd most common thyroid cancer (16%)
Clinical Findings
-Histo = small follicles w/ small, cuboidal cells and poor colloid formation.
-Carcinoma has capsule/vascular invasion whereas adenoma does not. FNA hard to do this so get frozen section @ surgery.
-Can synthesize thyroglobulin and concentrates iodine (thus radioactive iodine treatment works)
-Slightly more aggressive than papillary CA.
-Hurthle cell and poorly differentiated subtypes don't take up radioiodine and have higher mets/recurrence.
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