-IBIS-1.5.0-
tx
endocrine system
thyroid cancer
diagnoses
definition and etiology
definition: Neoplasm of the thyroid.
etiology: There are five types of thyroid tumor: most are found by the asymptomatic patient or physician during routine palpation of the gland: papillary, follicular, mixed (most common), medullary, and anaplastic (rare). These factors are implicated in a patient developing a thyroid tumor:
Age: Usually occurs in young people.
Sex: Since women have more thyroid disease then men, male patients with thyroid nodules raise the index of suspicion.
Amount of lesions: A solitary lesion is more suspicious as multiple lesions usually indicate multinodular goiter.
RAI uptake scan: A cold nodule is usually malignant; cancer rarely shows as a hot nodule.
X-ray findings: Indicative of medullary or papillary cancer.
Consistency: Malignant nodules appear "stony-hard".
Pertinent history: such as radiation to the head, neck, or chest.
Description of the three commonly seen types:
Papillary: the most commonly seen thyroid cancer, it is found 2-3 times more often in women than in men. Although seen more frequently in the young, it is a more serious malignancy in the senior citizen. It is often seen in patients who have had radiation exposure or Hashimoto's thyroiditis.
Follicular: responsible for approximately 25% of thyroid tumors and is seen more often in the elderly patient. It also is more common in females and has a history of radiation associated with its onset. As follicular cancer spreads through the blood, it more easily causes distant metastases and is therefore more malignant.
Medullary: usually seen in patients over 15 in either a sporadic form (typically unilateral) or with a familial association (typically bilateral). If associated with pheochromocytoma (in 50-75% of patients) and hyperparathyroidism (in 50% of patients), then is it known as Sipple's syndrome.
signs and symptoms
Thyroid nodule typically found on routine palpation.
lab findings:
RAI reveals cold nodule.
X-rays show homogenous calcification.
Excess of calcitonin: in medullary cancer.
Increased histamine levels: seen in 50% of patients, but not specific to thyroid disease.
May be hyperthyroid.
course and prognosis
Conventional treatment is generally thyroidectomy followed by lifelong replacement therapy with synthetic thyroid hormone. Survival rate is good.
differential diagnosis
Goiter.
Cyst.
footnotes