1) The thyroid gland is located in the lower front of the neck and produces thyroid hormones that regulate metabolism. 2) The main types of thyroid cancer are papillary carcinoma (60%), follicular carcinoma (20%), anaplastic carcinoma (10%), and medullary carcinoma (5%). 3) Diagnosis involves blood tests, ultrasound, and biopsy. Treatment options include surgery, radioactive iodine treatment, and thyroid hormone suppression. Prognosis is generally good if cancer is detected and treated early.

1. THYROID
MALIGNANCY
MADE BY: IN

2. ANATOMY
O Thyroid is an endocrine gland situated in lower
and sides of neck
O Extends from oblique of thyroid cartilage to 5th-
6th tracheal ring.
O Lie against C5,C6,C7 and T1
O It consists of two lobes joined by isthmus

3. c
 Blood supply:
O • Superior and inferior thyroid
O arteries.
O • Superior, middle and inferior thyroid
veins
 Lymphatic supply:
O Upper and lower deep cervical lymph
nodes
O Pretracheal and Para tracheal lymph
nodes

4. HISTOLOGY
O Thyroid has two types of cells
 Para follicular : it produces calcitonin which
regulates the calcium in the body
 Follicular epithelial cells: synthesise thyroid
hormones (T4 thyroxine and T3
triiodothyronine) by incorporating iodine into
amino acid tyrosine on the surface of
thyroglobulin(Tg) , a protein into the colloid of
follicle.

6. Types of neoplasms
 BENIGN NEOPLASMS:
• Colloid nodule
• Follicular adenoma
 MALIGNANT NEOPLASMS:
• Papillary carcinoma 60%
• Follicular carcinoma 20%
• Anaplastic carcinoma 10%
• medullary carcinoma 5%
• Malignant carcinoma 5%

7. Toxic adenoma
O A solitary toxic nodule is the cause of less than
5% of all causes of thyrotoxicosis.
O The nodule is follicular adenoma, which
secretes excess thyroid hormones and inhibits
endogenous TSH secretion with subsequently
atrophy of the thyroid gland.
O Most patients are females and over 40 yrs of
age
O The thyrotoxicosis is usually mild and in 50%
of the patients only T3 is elevated.

8. treatment
O Radioactive iodine is highly effective and
is an ideal treatment since the atrophic
cells surrounding the nodule do not take
up iodine and so receive little or no
radiation.
O Surgical hemi thyroidectomy is an
alternative.

9. Differentiated carcinoma
Follicular papillary
O accounts for 20%
O Common in iodine deficient
anaemia.
O Haematogenous spread
common (lungs and bones)
O Encapsulated, but there is
invasion of capsule
O Mortality rate 24%
O Accounts for 60%
O Most common thyroid
cancer
O Lymphatic spread is
common cervical lymph
nodes
O No capsule
O Orphan Annie eye nuclei
present(empty nuclei)
O Psammoma
bodies(dystrophic calcified
cancer cells)
O Mortality rate is 11%

12. Diagnosis and investigation
O TFT’S
O Thyroid auto-antibodies
O FNAC
O Neck ultrasound, MRI OR CT scan
O Incisional biopsy : not advised in
resectable carcinoma as it may cause
local recurrence but is justified in an
anaplastic and obviously irremovable
tumour.

13. management
 Surgical treatment:
 Thyroid lobectomy :minimum operation for thyroid
tumours. It is considered curative for minimal
papillary cancers(<1cm) and for minimally
invasive follicular cancers.
 Total thyroidectomy: it is indicated for cytological
proven cancers. It is indicated for papillary
cancers >1cm and for widely invasive follicular
cancers. It is combined with neck dissection in
patients with palpable lymphadenopathy.

14. cont.
 Medical treatment:
 Thyroxine: it is given to all patients after total
thyroidectomy and in majority of patients
after near total thyroidectomy.
it suppresses TSH production, as most
tumours are TSH dependent.
 radio- iodine: it is administered to patients
with thyroid cancer after total
thyroidectomy.
Effective in killing any residual thyroid cells
or malignant cells.

15. prognosis
O Most patients with papillary and thyroid cancers will
be cured with appropriate treatment.
O Adverse prognostic factors include :
• Older age
• Male sex
• Distant metastases
O But radio iodine therapy can treat even distant
metastases and so prolonged survival is quite
common.

16. Anaplastic(undifferentiated)
carcinoma and lymphoma
O The two conditions are difficult to distinguish
clinically but are distinct cytological and
histologically.
O Patients are usually over 60 yrs of age with
rapid thyroid enlargement in 2-3 months.
O Goitre is hard and there maybe stridor due to
tracheal compression and hoarseness due to
recurrent laryngeal nerve palsy.
O No effective treatment, although treatment
and surgery can be considered in some
patients but median survival rate is 7 months.

18. Cont.
O Prognosis for lymphoma, which may arise
from pre-existing hashimoto’s thyroiditis,
is better.
O Survival rate is 9 years.
O Some are non- Hodgkin's lymphomas,
usually the diffuse large B cell type.
O Treatment is combination chemotherapy,
CHOP(cyclophosphamide, doxorubicin ,
vincristine, prednisolone) and external
beam radiotherapy.

21. Medullary carcinoma
O This tumour arises from parafollicular C cells.
O It can occur sporadically or in families as part
of MEN TYPE 2 syndrome.
O It secretes calcitonin and may secrete 5-
hydroxytryptamine (5HT, serotonin),
adrenocorticotrophic hormone(ACTH) and
prostaglandins.
O Patients usually present in middle age with
firm thyroid mass.
O Cervical lymph node involvement is common
but distant metastases are rare.

22. Cont.
O Serum calcitonin levels are inc. and are useful
in monitoring response to treatment.
O Due to high levels of calcitonin,
hypocalcaemia is rare but
hypercalcitoninaemia can be associated with
severe, watery diarrhoea.
O Treatment by total thyroidectomy with removal
of regional cervical lymph nodes.
O There is no Role of radio iodine or TSH
suppression levothyroxine.
O Prognosis is less than papillary and follicular
carcinoma but individuals live for many
decades.

24. Riedel’s thyroiditis
O This is not a form of thyroid cancer but the
presentation is similar and can only be
differentiated by thyroid biopsy.
O Slow growing goitre which is irregular and
stony hard and usually there is
oesophageal and tracheal compression.
O Other complications include recurrent
laryngeal nerve palsy ,
hypoparathyroidism and hypothyroidism.