Surgical Treatment of Thyroid disease

Radiation exposure (childhood) ⭐

Family history of thyroid cancer (MEN2, medullary)

Rapid growth

Male sex (fewer nodules but higher malignancy risk)

risk factors for thyroid malignancy

Neck fullness

Dysphagia

Dyspnea (tracheal compression)

Hoarseness

symptoms of goiter

Graves disease

carotid bruit is associated with this thyroid pathology

1. TSH

2. Radioiodine scan

3. Ultrasound

4. FNA

stepwise approach to thyroid nodules

Hypoechoic

Microcalcifications

Irregular margins

Taller-than-wide

suspicious ultrasound features of a thyroid nodule

fine needle aspiration

gold standard for diagnosis of thyroid nodule

hot nodules

the hyperfunctioning thyroid nodules seen on a nuclear medicine study that are almost always benign

-no FNA needed

Suspicious or malignant on FNA

Large/compressive symptoms

Indeterminate biopsy

surgical indications for a thyroid nodule

toxic multinodular goiter

-one/more nodules in multinodular goiter become TSH-independent

-no exophthalmos/pretibial myxedema

toxic adenoma

cause hyperthyroid

benign, metabolically active thyroid nodule

radioactive iodine

Used for hyperthyroidism and thyroid cancer

Absorbed by thyroid and destroys its cells

tracheoesophageal groove

the recurrent laryngeal nerve runs in this groove

hoarseness

unilateral RLN injury resluts in

airway complications

bilateral recurrent laryngeal nerve injury results in

Perioral numbness

Tetany

Chvostek/Trousseau signs

signs of parathyroid injury in thyroid surgery

papillary

most common thyroid cancer

Orphan Annie nuclei, psammoma bodies

histology of papillary thyroid cancer

lymphatic

spread of papillary thyroid cancer

excellent

prognosis of papillary thyroid cancer

follicular thyroid carcinoma

A well differentiated tumor of the follicular cells of the thyroid gland. It is a slowly growing, painless, cold nodule.

Hematogenous (bone/lung)

spread of follicular thyroid cancer

good

prognosis of follicular thyroid cancer

medullary thyroid cancer

neuroendocrine tumor of parafollicular C cells of thyroid

produce calcitonin and present as solitary thyroid nodules in 70-95% patients.

MEN2

disease associated with medullary thyroid carcinoma

Surgery ONLY (no RAI)

treatment of medullary thyroid carcinoma

intermediate

prognosis of medullary thyroid cancer

anaplastic thyroid cancer

Rare <1%

MC in males >65

Local and distant METS; may invade trachea

Poor prognosis*

tx: most are not able to be resected, chemo and radiation

local invasion, very poor prognosis

spread of anaplastic carcinoma

palliative

treatment of anaplastic thyroid cancer