Thyroid malignancy

Most primary thyroid cancers originate in the …

Parafollicular cells

Risk factors of thyroid malignancy

History of MENS syndrome, head and neck irradiation and family Hx of thyroid cancer

Signs and symptoms overall of thyroid malignancy

Palpable firm neck mass, enlarged cervical lymph nodes, hoarseness, voice changes or cough, trouble swallowing or breathing

Most common and most curable thyroid cancer

Papillary

Strong indicators of thyroid malignancy

Absent halo sign, microcalcifications and intra-nodular flow patterns

Microcalcifications are also known as

Psammoma bodies

Color in malignant nodules

Central and perinodular hypervascualrity

Papillary cancer

75-90%

More common in women

Painless neck lump

Slow growing

Usually a solitary nodule

Treated with thyroid lobectomy and hormone therapy

USA papillary cancer

Heterogeneous, hypoechoic solid mass

May see microcalcifications (psammoma bodies)

Associated with enlarged cervical lymph nodes due to mets

Hypervascularity in most cases

Papillary carcinoma

Follicular cancer

Rare thyroid malignancies

Frequency increases with age

More common in women

Usually solitary mass

Slow growing

Follicular cancer USA

May be similar appearance to benign adenoma but can demonstrate irregular margins

Thickened halo

Chaotic arrangement of internal blood vessels

Follicular cancer

Adenocarcinoma

Rare thyroid malignancy

Moderately aggressive

Medullary cancer

Hard bulky mass

Usually found in 5th and 6th decades

Sipple syndrome - medullary cancer + parathyroid cancer + pheochromocytoma

Associated with MEN syndrome

Secretes calcitonin

Most commonly bilateral and/or multicentric

Medullary carcinoma

Hurthle cell carcinoma

10-12% thyroid malignancies

Slow growing

Giant and Spindle Cell Carcinoma is also known as

Anaplastic cancer

Giant and Spindle Cell Carcinoma

10% thyroid malignancies

Very aggessive

Most lethal type thyroid malignancy

Hard, fixed mass with rapid growth

Usually invades surrounding neck structures

Can cause death by compression of trachea or infiltration into trachea occluding airway

USA Giant and Spindle Cell Carcinoma

Usually hypoechoic with ill-defined borders

Neck muscle and/or blood vessel invasion

Encases blood vessels

Compresses trachea

Mets to thyroid

Melanoma, breast, renal and lung cancer are most common primary cancers

Mets to thyroid

Antibody levels that are monitored in thyroidectomy pts

Thyroglobulin and thyroglobulin antibody levels

Increasing thyroglobulin levels and thyroglobulin antibody levels in a post-surgical pt can indicate

Recurrance

If a pt had a complete thyroidectomy there should be no _________ present in the blood

Thyroglobulin

Normal lymph node USA

Ovoid in shape

No posterior enhancement

Hyperechoic hilum with hypoechoic cortex

Abnormal lymph node USA

Round shape

Plump anechoic cortex causes decreased visualization of the central hilum

Local hilum with color

Posterior enhancement is present in structures posterior to abnormal nodules with significant fluid accumulation

Scanning lymph

Begin in the upper neck with the submental, submandibular, parotid and jugulodigastric regions then angle posteriorly as you move down

Pt position for scanning lymph nodes

Pt neck supine, neck extended and rotated toward the contralateral side

What thyroid levels are most commonly affected by tumor recurrence?

III and IV

Sonopalpation

Deep palpation of the mass with the transducer may produce focal pain, which may radiate along the nerve pathway

Level I

Under the jaw

Level II

Base of the skull to hyoid bone

Level III

Hyoid bone to cricoid cartilage

Level IV

From cricoid cartilage to clavicle

Level V

Adjacent to sternocleidomastoid muscle

Level VI

Hyoid bone to manubrium

Level VII

Inferior to clavicle

Normal lymph node

Abnormal lymph node

After thyroidectomy due to cancer, why are serial neck ultrasound exams performed annually on these pts

To evaluate the cervical lymph nodes

Psammoma bodies are commonly seen in what type of thyroid cancer?

Papillary

What type of thyroid malignancy appears similar to a benign adenoma, but has irregular borders?

Follicular

What type of thyroid cancer is associated with MEN syndrome

Medullary

What hormone is secreted by a medullary carcinoma mass?

Calcitonin

Most aggressive and lethal type of thyroid cancer

Anaplastic/Giant cell

Lymph nodes located adjacent to which of the following structures should be evaluated in a post-thyroidectomy pt?

Sternocleidomastoid muscle, CCA, and IJV