1) Thyroid nodules are common findings that require evaluation to determine if they are malignant or benign.
2) Evaluation involves patient history, physical exam, laboratory tests like TSH, ultrasound of the thyroid, and fine needle aspiration biopsy of suspicious nodules.
3) Most nodules are benign but ultrasound and biopsy help determine the small percentage that require surgical removal due to cancer risk.
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. INTRODUCTION
• Discrete lesion within thyroid gland that is
radiologically distinct from surrounding parenchyma
• Noted by patient, or as an incidental finding
• May be
Palpable or impalpable,
Functioning or nonfunctioning
3. EPIDEMIOLOGY:
• Framingham study
Ages 35 – 59
Women 6.4 %
Men 1.5 %
• Prevalence increases with
Age
Exposure to ionizing
radiation (Nodule in
radiated patient: 35-40%
cancer)
• Pregnancy increases risk
4. • Represents a
wide spectrum
of disease
• Most are,
Colloid nodules,
Adenomas
Cysts,
Focal thyroiditis
• Only 5-6% are
malignant
5.
6. CLINICAL ASSESSMENT: HISTORY AND
PHYSICAL EXAMINATION
• History:
• Younger and older patients (m >40yrs and F >50yrs) more
likely to have malignant thyroid nodule
• Children may present with more advanced disease
• Incidence F>M, but aggressiveness M>F
• Rapid growth of a preexisting or new thyroid nodule
(hemorrhage into cyst / carcinoma)
• Throat or neck pain (hemorrhage into benign nodule, rarely
as/w carcinoma)
7. • Compressive or invasive symptoms like
Voice change
Hoarseness
Dysphagia
Dyspnea
• Symptoms of hyperthyroidism and hypothyroidism should be
explored
• Family history
• H/o previous head and neck radiation exposure
• H/o medullary carcinoma, pheochromocytoma, or
hyperparathyroidism (MEN syndromes)
8. • Physical examination:
• Careful palpation of thyroid
(solitary or dominant nodule in
multinodular gland )
• Firm nodule 2-3 times
increased risk of carcinoma
• Substernal extension estimated
by relationship of inf aspect of
mass to clavicle
• Thoracic inlet obstruction by
Pemberton maneuver
9. • Physical findings suggesting possible malignancy include
Vocal cord paralysis
Cervical lymphadenopathy (also in Hashimoto thyroiditis,
Graves disease, or infection)
Fixation of nodule to surrounding tissues
10. INVESTIGATION
• Lab investigations :
CBC, ESR for inflammatory or infectious thyroiditis
TFT, Most patients are euthyroid
TSH is an independent risk factor for predicting malignancy
TPO antibodies in pts with high TSH (Hashimoto's
thyroiditis)
Serum calcitonin is elevated in medullary carcinoma of
thyroid
24-hour urine for metanephrines and catecholamines
Serum calcium to exclude hyperparathyroidism
11. • Radiography :
Not routinely
done
May show
Tracheal
deviation or
compression
Pulmonary
metastasis
Calcifications
12. • Ultrasound scanning :
• Noninvasive and inexpensive
• Detect non palpable nodules
• Differentiate between cystic and
solid nodules
• Identify hemiagenesis and
contralateral lobe hypertrophy
misdiagnosed as thyroid nodule
• Detect cervical nodes that may
contain early clinically occult
metastatic disease
13. • Features as/w low risk of
thyroid Ca
• Features as/w Increased risk
of thyroid Ca
14.
15.
16.
17. • Computed tomography (CT) and MRI :
• Usually unnecessary
• Useful in determining
Substernal extension
Identifying cervical and mediastinal adenopathy
Evaluating relationship of thyroid lesion to adjacent neck strs
(trachea and esophagus)
• MRI is more accurate in distinguishing recurrent or
persistent thyroid tumor from postoperative fibrosis
18. • FNAC :
• Emerged in 1970s
• Procedure of choice in evaluation of thyroid nodules
• Minimally invasive
• Improved diagnostic accuracy
• Higher malignancy yield at the time of surgery
• Significant cost reductions
• Specifity : 72 – 100% , sensitivity : 65 – 98%
20. Respective risk of malignancy associated with each
diagnostic category (Bethesda System) is
1. Non diagnostic
2. Benign - < 1%
3. Atypia of undetermined significance/ follicular lesion of
undetermined significance (AUS/FLUS) - 5-10%
4. Follicular neoplasm/suspicious - 20-30%
5. Suspicious for malignancy - 50-75%
6. Malignant - 100%
21. • Thyroid nodule diagnostic FNA is recommended for:
A) Nodules > 1cm in greatest dimension with high suspicion
sonographic pattern
B) Nodules > 1 cm in greatest dimension with intermediate
suspicion sonographic pattern
C) Nodules > 1.5cm in greatest dimension with low suspicion
sonographic pattern
D) Nodules > 2cm in greatest dimension with very low
suspicion sonographic pattern
22.
23.
24.
25.
26.
27. • Limitations of FNAC :
• False-positive results (difficulties in interpreting cytology)
Hashimoto thyroiditis
Graves disease
Toxic nodules
• Cannot distinguish follicular adenoma from carcinoma
28.
29. • Thyroid scintigraphy :
• Should be performed in patients with low serum TSH
• Utilizes one of iodine radioisotopes (usu. I123) or
technetium-99m pertechnetate
• Others : Thallium-201 scan, Gallium-67, Tc-99m sestamibi
• Most benign and virtually all malignant thyroid nodules
concentrate both radioisotopes less avidly
30. • Advantage of technetium :
a. Required in smaller dose
b. Less expensive
c. Less radiation exposure
d. Shorter ½ life
• Disadvantage:
1. Only tests iodine transport (I123 also organification of I)
2. Hot nodules require I123 scanning for confirmation
3. Does not penetrate sternum - not useful in sub-sternal
extension
31. • Hyper functioning - ‘‘HOT’’
tracer uptake is greater than
surrounding thyroid (~5%
malignant)
• Iso-functioning - ‘‘WARM’’-
tracer uptake is equal to
surrounding thyroid (~10%
malignant)
• Non-functioning - ‘‘COLD ’’
uptake less than surrounding
thyroid (~20% malignant)
32.
33. • Indeterminate :
• Superimposition of abnormal nodular tissue and normally
functioning thyroid tissue
• Should be evaluated by FNA
• Can be also be assessed by suppression scanning
Thyroid hormone sufficient to suppress TSH secretion
(2 mcg/kg for 10 days)
Second scan once TSH suppression documented
Uptake of radioiodine low or undetectable in non-
autonomous, but persist in autonomous tissue