This document provides an overview of evaluating neck masses, with a focus on the thyroid gland. It discusses the anatomy of the neck, characteristics of common neck masses, diagnostic tools such as biopsy and imaging, and characteristics and management of various thyroid conditions. Prominent topics include thyroid cancer risk factors, symptoms of malignant thyroid nodules, and examination findings suggestive of thyroid cancer.
this presentation discusses how to approach to the neck mass
and important DDx according to the site and age of onset
with clinical points about important etiologies
While lung cancer remains a very challenging cancer to treat, new treatments that capitalize on advances in our understanding of cancer. It is likely that a more personalized approach to treatment using biological markers and combinations of therapies will provide better results in the future.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
this presentation discusses how to approach to the neck mass
and important DDx according to the site and age of onset
with clinical points about important etiologies
While lung cancer remains a very challenging cancer to treat, new treatments that capitalize on advances in our understanding of cancer. It is likely that a more personalized approach to treatment using biological markers and combinations of therapies will provide better results in the future.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests. Evidence quality can range from meta-analyses and systematic reviews of double-blind, placebo-controlled clinical trials at the top end, down to conventional wisdom at the bottom.
The literature review usually precedes a research proposal and results section. Its goals are to situate the current study within the body of literature and to provide context for the particular reader. Literature reviews are important for research in nearly every academic field.
The 6 Thinking hats ensures that groups think together in a focused manner, staying on task, & ensures that they focus their efforts on the most important elements of any issue being discussed.
The naso-orbitoethmoid complex (NOE) fracture represents the most wearisome and challenging of all facial fractures due to the complexity and intricacy of its surgical & anatomic components. A good working knowledge with regards its surgical anatomy, clinical features, sequence of treatment & surgical approaches, potential pitfalls in its treatment & postoperative consideration,. Appropriate diagnosis and timely treatment is crucial to avoid unfavorable & difficult to treat sequelae.
Clinical & surgical management of the mandibular condylar process fractures has generated a great deal of controversy in maxillofacial trauma and there are many various approaches to treat this injury. Before, many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but recently open treatment of condylar fractures with rigid internal fixation (RIF) has become more common & acceptable. The objective of this presentation was to evaluate the factors that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.
Frontal sinus fractures are currently managed by various medical specialists, including otolaryngologists/head and neck surgeons, maxillofacial surgeons, plastic surgeons, and neurosurgeons. As a result, consensus does not exist regarding the timing, indications, and treatment modality of these injuries.
Vertigo is a subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system.
For every new medicine we discover & invent - antibiotic resistance develops to the older one. For every microorganism that we eradicate, another one emerges to take its place.
i) The Vision of this Residents-in-training Manual is to create a perfect guide which is appropriate, competent & adaptive to the changing regional needs and culture of specialty training & dynamic enough to meet the demands of technology change, innovations in management & medical advancement.
The Vision of this BGH MC Residents-in-training Manual is to create a perfect guide which is appropriate, competent & adaptive to the changing regional needs and culture of specialty training & dynamic enough to meet the demands of technology change, innovations in management & medical advancement.
Many radiolucent or mixed radiolucent/radiopaque lesions of the mandible & maxilla may present as incidental findings on radiographs or as the main symptom of a patient. Complete history & physical examination with appropriate radiographic examination & pathologic confirmation completes the management of these diseases.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
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for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
11. History
Developmental time course
Associated symptoms (dysphagia, otalgia, voice)
Personal habits (tobacco, alcohol)
Previous irradiation or surgery
Physical Examination
Complete head and neck exam (visualize & palpate)
Emphasis on location, mobility and consistency
12. Inflammatory mass suspected
Two week trial of antibiotics
Follow-up for further investigation
14. Standard of diagnosis
Indications
Any neck mass that is not an obvious
abscess
Persistence after a 2 week course of
antibiotics
Small gauge needle
Reduces bleeding
Seeding of tumor – not a concern
No contraindications (vascular ?)
15.
16. Distinguish cystic from
solid
Extent of lesion
Vascularity (with contrast)
Detection of unknown
primary (metastatic)
Pathologic node (lucent,
>1.5cm, loss of shape)
Avoid contrast in thyroid
lesions
17. Similar
informati
on as CT
Better for
upper
neck and
skull
base
Vascular
delineati
on with
infusion
18. Less important
now with FNAB
Solid versus cystic
masses
Congenital cysts
from solid
nodes/tumors
Noninvasive
(pediatric)
19. Salivary and thyroid
masses
Location – glandular
versus extra-glandular
Functional information
FNAB now preferred for
for thyroid nodules
Solitary nodules
Multinodular goiter
with new increasing
nodule
Hashimoto’s with new
nodule
20. Any solid asymmetric mass MUST
be
considered a metastatic neoplastic
lesion until proven otherwise
Asymptomatic cervical mass
12% of cancer
~ 80% of these are SCCa
21. Ipsilateral otalgia with normal otoscopy –
direct attention to tonsil, tongue base,
supraglottis and hypopharynx
Unilateral serous otitis – direct examination
of nasopharynx
22. Panendoscopy
FNAB positive with no primary on repeat exam
FNAB equivocal/negative in high risk patient
Directed Biopsy
All suspicious mucosal lesions
Areas of concern on CT/MRI
None observed – nasopharynx, tonsil
(ipsilateral tonsillectomy for jugulodigastric
nodes), base of tongue and piriforms
Synchronous primaries (10 to 20%)
23. Unknown primary
University of Florida (August, 2001)
Detected primary in 40%
Without suggestive findings on CT or panendoscopy
yield dropped to 20%
Tonsillar fossa in 80%
24. Open excisional biopsy
Only if complete workup negative
Occurs in ~5% of patients
Be prepared for a complete neck dissection
Frozen section results (complete node
excision)
Inflammatory or granulomatous – culture
Lymphoma or adenocarcinoma – close
wound
25. Congenital masses
Benign lesions
Vascular and lymphatic malformations
Infectious and inflammatory conditions
Malignant lesions
26. Thyroid mass Carotid body
Lymphoma and glomus
Salivary tumors tumors
Lipoma Neurogenic
tumors
27. Leading cause of anterior
neck masses
Children
Most common neoplastic
condition
Male predominance
Higher incidence of
malignancy
Adults
Female predominance
Mostly benign
28. Lymph node metastasis
Initial symptom in 15% of papillary
carcinomas
40% with malignant nodules
Histologically (microscopic) in >90%
FNAB has replaced USG and radionucleotide
scanning
Decreases # of patients with surgery
Increased # of malignant tumors found at
surgery
Doubled the # of cases followed up
Unsatisfactory aspirate – repeat in 1 month
32. Usually picked up on routine physical exam or
as incidental finding
Patients may have clinical or subclinical
thyrotoxicosis
Patients may have compressive symptoms:
tracheal, vascular, esophageal, recurrent
laryngeal nerve
34. Antithyroid Drugs
May require prolonged therapy
Radioactive iodine
May worsen ophthalmopathy unless
followed by steroids
Surgery
Make patient euthyroid prior to surgery
Potassium iodide two weeks prior to surgery
can decrease the vascularity of the gland
35. Autonomously functioning thyroid nodule
hypersecreting T3 and T4 resulting in
thyrotoxicosis (Plummer’s disease)
Almost never malignant
Manage with antithyroid drugs followed by
either I-131 or surgery
36. Also known as Hashimoto’s disease
Probably the most common cause of
hypothyroidism
Autoantibodies include: thyroglobulin
antibody, thyroid peroxidase antibody, TSH
receptor blocking antibody
37. Painless goiter in a patient who is either
euthyroid or mildly hypothyroid
Low incidence of permanent hypothyroidism
May have periods of thyrotoxicosis
Treat with levothyroxine
38. Also known as De Quervain's
thyroiditis
Most common cause of thyroid pain and
tenderness
Acute inflammatory disease most likely due to
viral infection
Transient hyperthyroidism followed by
transient hypothyroidism; permanent
hypothyroidism or relapses are uncommon
39. Symptomatic: NSAIDS or a
glucocorticoid
Beta-blockers indicated if there are
signs of thyrotoxicosis
Levothyroxine may be given during
hypothyroid phase
40. Rare disorder usually affecting middle-aged
women
Likely autoimmune etiology
Fibrous tissue replaces thyroid gland
Patients present with a rapidly
enlarging hard neck mass
41. 1.0%-1.5% of all new cancer cases
tenfold less than that of lung,
breast, or colorectal cancer
8,000-14,000 new cases diagnosed each year
(Sessions, 1993, Geopfert, 1998)
3% of patients who die of other causes have
occult thyroid cancer and 10% have microscopic
cancers (Robbins, 1991)
35% of thyroid gland at autopsy in some studies
have papillary carcinomas (<1.0cm) (Mazzaferri,
1993)
42. 1,000-1,200 patients in the U.S. die each year of
thyroid cancer (Goldman, 1996)
4%-7% of adults in North America have
palpable thyroid nodules (Mazzaferri, 1993, Vander,
1968)
4:1 women to men (Mazzaferri, 1993)
Overall, fewer than 5% of nodules are malignant
(Mazzaferri, 1988)
43. Symptoms
The most common presentation of a thyroid
nodule, benign or malignant, is a painless mass
in the region of the thyroid gland (Goldman, 1996).
Symptoms consistent with malignancy
Pain
dysphagia
Stridor
hemoptysis
rapid enlargement
hoarseness
44. Risk factors
Thyroid exposure to irradiation
low or high dose external irradiation (40-50 Gy
[4000-5000 rad])
especially in childhood for:
large thymus, acne, enlarged tonsils, cervical
adenitis, sinusitis, and malignancies
30%-50% chance of a thyroid nodule to be
malignant (Goldman, 1996)
Schneider and co-workers (1986) studied, with
long term F/U, 3000 patients who underwent
childhood irradiation.
1145 had thyroid nodules
318/1145 had thyroid cancer (mostly papillary)
45. Family History
History of family member with medullary
thyroid carcinoma
History of family member with other endocrine
abnormalities (parathyroid, adrenals)
History of familial polyposis (Gardner’s
syndrome)
46. Examination of the thyroid nodule:
consistency - hard vs. soft
size - < 4.0 cm
Multinodular vs. solitary nodule
multi nodular - 3% chance of malignancy
(Goldman, 1996)
solitary nodule - 5%-12% chance of
malignancy (Goldman, 1996)
Mobility with swallowing
Mobility with respect to surrounding tissues
Well circumscribed vs. ill defined borders
47. Examine for ectopic thyroid tissue
Indirect or fiberoptic laryngoscopy
vocal cord mobility
evaluate airway
preoperative documentation of any
unrelated abnormalities
Systematic palpation of the neck
Metastatic adenopathy commonly found:
in the central compartment (level VI)
along middle and lower portion of the
jugular vein (regions III and IV) and
Attempt to elicit Chvostek’s sign
49. Advantages
Most sensitive procedure or identifying lesions
in the thyroid (2-3mm)
90% accuracy in categorizing nodules as solid,
cystic, or mixed (Rojeski, 1985)
Best method of determining the volume of a
nodule (Rojeski, 1985)
Can detect the presence of lymph node
enlargement and calcifications
Noninvasive and inexpensive
50. Currently considered to be the best first-line
diagnostic procedure in the evaluation of the thyroid
nodule:
Advantages:
Safe
Cost-effective
Minimally invasive
Leads to better selection of patients for
surgery than any other test (Rojeski, 1985)
51. Mechanism/Rationale
Exogenous thyroid hormone feeds back to
the pituitary to decrease the production of
TSH
Cancer is autonomous and does not require
TSH for growth whereas benign processes do
Thyroid masses that shrink with suppression
therapy are more likely to be benign
Thyroid masses that continue to enlarge are
likely to be malignant
52. Limitations:
16% of malignant nodules are suppressible
Only 21% of benign nodules are suppressible
Provides little use in distinguishing benign from
malignant nodules
(Geopfert, 1998)
53. Uses:
Preoperative
patients with nonoxyphilic follicular neoplasms
patients with solitary benign nodules that are
nontoxic (particularly men and premenopausal
women)
women with repeated nondiagnostic tests
Postoperative
Use in follicular, papillary and Hurthle cell
carcinomas
(Geopfert, 1998, Mazzaferri, 1993)
54. How to use thyroid suppression
administer levothyroxine
maintain TSH levels at <0.1 mIU/L
use ultrasound to monitor size of nodule
if the nodule shrinks, continue L-thyroxine
maintaining TSH at low-normal levels
if the nodule has remained the same size after 3
months, reaspirate
if the nodule has increased in size, excise it
(Geopfert, 1998,)
56. Pathogenesis - unknown
Papillary has been associated with the RET proto-
oncogene but no definitive link has been proven
(Geopfert, 1998)
Certain clinical factors increase the likelihood of
developing thyroid cancer
Irradiation - papillary carcinoma
Prolonged elevation of TSH (iodine deficiency) -
follicular carcinoma (Goldman, 1996)
relationship not seen with papillary carcinoma
mechanism is not known
57. 60%-80% of all thyroid cancers (Geopfert, 1998, Merino, 1991)
Histologic subtypes
Follicular variant
Tall cell
Columnar cell
Diffuse sclerosing
Encapsulated
Prognosis is 80% survival at 10 years (Goldman, 1996)
Females > Males
Mean age of 35 years (Mazzaferri, 1994)
58. Lymph node involvement is common
Major route of metastasis is lymphatic
46%-90% of patients have lymph node involvement
(Goepfert, 1998, Scheumann, 1984, De Jong, 1993)
Clinically undetectable lymph node involvement does not
worsen prognosis (Harwood, 1978)
59. 20% of all thyroid malignancies
Women > Men (2:1 - 4:1) (Davis, 1992, De Souza, 1993)
Mean age of 39 years (Mazzaferri, 1994)
Prognosis - 60% survive to 10 years (Geopfert, 1994)
Metastasis - angioinvasion and hematogenous
spread
15% present with distant metastases to bone and lung
Lymphatic involvement is seen in 13% (Goldman,
1996)
60. Variant of follicular carcinoma
First described by Askanazy
“Large, polygonal, eosinophilic thyroid follicular cells
with abundant granular cytoplasm and numerous
mitochondria” (Goldman, 1996)
Definition (Hurthle cell neoplasm) - an
encapsulated group of follicular cells with at least
a 75% Hurthle cell component
Carcinoma requires evidence of vascular and
capsular invasion
4%-10% of all thyroid malignancies (Sessions, 1993)
61. Depending on variables, patients are categorized
in to one of the following three groups:
1) Low risk group - men younger than 40
years and women younger than 50 years
regardless of histologic
type
- recurrence rate -11%
- death rate - 4%
(Cady and Rossi, 1988)
62. 1) Intermediate risk group - Men older than 40
years and women older than 50 years who have
papillary carcinoma
- recurrence rate - 29%
- death rate - 21%
2) High risk group - Men older than 40 years and
women older than 50 years who have follicular
carcinoma
- recurrence rate - 40%
- death rate - 36%
63. 10% of all thyroid malignancies
1000 new cases in the U.S. each year
Arises from the parafollicular cell or C-cells of the
thyroid gland
derivatives of neural crest cells of the branchial arches
secrete calcitonin which plays a role in calcium
metabolism
64. Familial MTC:
Autosomal dominant transmission
Not associated with any other endocrinopathies
Mean age of 43
Multifocal and bilateral
Has the best prognosis of all types of MTC
100% 15 year survival
(Farndon, 1986)
65. Multiple endocrine neoplasia IIa (Sipple’s
Syndrome):
MTC, Pheochromocytoma, parathyroid
hyperplasia
Autosomal dominant transmission
Mean age of 27
100% develop MTC (Cance, 1985)
85%-90% survival at 15 years (Alexander, 1991,
Brunt, 1987)
66. Multiple endocrine neoplasia IIb (Wermer’s
Syndrome, MEN III, mucosal syndrome):
Pheochromocytoma, multiple mucosal
neuromas, marfanoid body habitus
90% develop MTC by the age of 20
Most aggressive type of MTC
15 year survival is <40%-50%
(Carney, 1979)
67. Highly lethal form of thyroid cancer
Median survival <8 months (Jereb, 1975, Junor, 1992)
1%-10% of all thyroid cancers (Leeper, 1985, LiVolsi, 1987)
Affects the elderly (30% of thyroid cancers in
patients >70 years) (Sou, 1996)
Mean age of 60 years (Junor, 1992)
53% have previous benign thyroid disease
(Demeter, 1991)
47% have previous history of WDTC (Demeter, 1991)
68. Surgery is the definitive management of thyroid
cancer, excluding most cases of ATC and lymphoma
Types of operations:
lobectomy with isthmusectomy - minimal operation
required for a potentially malignant thyroid nodule
total thyroidectomy - removal of all thyroid tissue
- preservation of the contralateral
parathyroid glands
subtotal thyroidectomy - anything less than a total
thyroidectomy
69. Rationale for total thyroidectomy
1) 30%-87.5% of papillary carcinomas involve
opposite lobe (Hirabayashi, 1961, Russell, 1983)
2) 7%-10% develop recurrence in the contralateral
lobe (Soh, 1996)
3) Lower recurrence rates, some studies show
increased survival (Mazzaferri, 1991)
4) Facilitates earlier detection and tx for recurrent
or metastatic carcinoma with iodine (Soh, 1996)
5) Residual WDTC has the potential to
dedifferentiate to ATC
70. Rationale for subtotal thyroidectomy
1) Lower incidence of complications
Hypoparathyroidism (1%-29%) (Schroder, 1993)
Recurrent laryngeal nerve injury (1%-2%)
(Schroder, 1993)
Superior laryngeal nerve injury
2) Long term prognosis is not improved by
total thyroidectomy (Grant, 1988)
71. Indications for total thyroidectomy
1) Patients older than 40 years with papillary or follicular
carcinoma
2) Anyone with a thyroid nodule with a history of
irradiation
3) Patients with bilateral disease
72. Postoperative therapy/follow-up
Radioactive iodine (administration)
Scan at 4-6 weeks postop
repeat scan at 6-12 months after ablation
repeat scan at 1 year then...
every 2 years thereafter
73. Postoperative therapy/follow-up
Thyroglobulin (TG) (Gluckman)
measure serum levels every 6 months
Level >30 ng/ml are abnormal
Thyroid hormone suppression (control TSH
dependent cancer) (Goldman, 1996)
should be done in - 1) all total thyroidectomy
patients
2) all patients who have had
radioactive ablation of any
remaining thyroid tissue
74. Most have extensive extrathyroidal
involvement at the time of diagnosis
surgery is limited to biopsy and tracheostomy
Current standard of care is:
maximum surgical debulking, possible
adjuvant radiotherapy and chemotherapy
(Jereb and Sweeney, 1996)