This document summarizes the key clinical features of the main types of thyroid malignancy: - Papillary carcinoma presents as a solitary or multinodular thyroid swelling and often palpable neck lymph nodes. - Follicular carcinoma appears as a firm or hard nodular swelling in the neck and can cause tracheal compression or infiltration of the lungs or recurrent laryngeal nerve. - Anaplastic carcinoma causes a rapidly progressive hard swelling in the thyroid region with potential tracheal obstruction or dysphagia. - Medullary carcinoma presents with a thyroid swelling and enlarged neck nodes, and may cause diarrhea or flushing in association with MEN II syndrome.

1. THYROID MALIGNANCY
CLINICAL FEATURES
NEETHI.T.P
ROLL NO: 29

2. PAPILLARY CARCINOMA OF THYROID
CLINICAL FEATUTES
• Thyroid swelling – soft or firm or hard
solid or cystic
solitary or multinodular
• Compression features are uncommon
• Often descrete lymphnodes in the neck (40%) are
palpable
• This may present with secondaries in neck
lymphnodes with occult primary

3. FOLLICULAR CARCINOMA
CLINICAL FEATURES
• Swelling in the neck- firm or hard and nodular
• Tracheal compression/ infiltration & stridor
• Dyspnoea, haemoptysis, chest pain when
there are lung secondaries

5. • Hoarseness of voice if recurrent laryngeal
nerve involvement occurs
• Absence of carotid pulsation, if lesion infiltrate
into carotid sheath (positive berry’s sign)
• Pulsatile secondaries in skull and longbones

8. CLINICAL SCORING SYSTEMS
• AMES clinical scoring system
Based on Age
distant Metastasis
Extent of primary tumour
Size of primary tumour

9. • AGES clinical scoring system
Based on Age
pathologic Grade of the tumour
Extent of the tumour
Size of the tumour

10. Prgnostic risk classification for patients
based on AMES or AGES
Risk
parameter
LOW
HIGH
age
<40
>40
gender
female
male
extent
No local extension,
intrathyroidal, no capsular
invasion
Capsular invasion,
extrathyroidal extension
metastasis
none
Regional or distant
size
<2 cm
>4 cm
grade
Well differentiated
Poorly differentiated

11. ANAPLASTIC CARCINOMA
CLINICAL FEATURES
• Swelling in thyroid region- rapidly progressive
hard with involvement of isthmus and lateral
lobes
• Stridor and hoarseness of voice due to
tracheal obstruction
• Dysphagia
• Fixity to the skin
• Positive berry’s sign

14. MEDULLARY CARCINOMA
CLINICAL FEATURES
• Thyroid swelling often with enlargement of neck
nodes
• Diarrhoea, flushing (30 %)
• Hypertension, pheochromocytoma, and mucosal
neuromas when associated with MEN II syndrome

15. • Sporadic and familial types occur in adulthood
• Cases associated with MEN II syndrome occur
in younger age group
• Paraneoplastic syndrome like cushing’s,
carcinoids may be present.

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