This document outlines the TNM staging system for thyroid malignancies and describes treatment approaches for the main types of thyroid cancer. It discusses staging based on tumor size and extent, node involvement, and presence of metastases. Total thyroidectomy is the primary treatment for papillary and follicular carcinomas to allow for radioiodine ablation and TSH suppression. Lobectomy may be an option for smaller papillary cancers. Lymph nodes are typically removed through functional neck dissection. Anaplastic carcinoma has a low resectability rate due to local invasion, and radiotherapy is used palliatively. Total thyroidectomy with radical neck dissection is recommended for medullary carcinoma.
The data on thyroid tumors in the fourth edition of the World Health Organization (WHO) classification of endocrine tumors published in 2017 contain significant revisions.
These revisions of the 2004 WHO classification were based on new knowledge about pathology, clinical behavior, and most importantly the genetics of the thyroid tumors.
The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism. Fewer than 1% of all thyroid nodules are malignant (cancerous). Females are more likely to have thyroid cancer at a ratio of 3:1. The cause of thyroid cancer is unknown, but certain risk factors have been identified and include a family history of goiter, exposure to high levels of radiation, and certain hereditary syndromes
It is unclear whether the administration of radioiodine provides any benefit in low-risk cases after a complete surgical resection, and radioiodine is not recommended in patients with disease that is categorized as consisting of a tumor less than 1 cm in diameter and clinical stage N0. Therefore, radioiodine should be used with great care to minimize harm, administer the minimal amount of radioactivity, and involve the best tolerated methods.
The data on thyroid tumors in the fourth edition of the World Health Organization (WHO) classification of endocrine tumors published in 2017 contain significant revisions.
These revisions of the 2004 WHO classification were based on new knowledge about pathology, clinical behavior, and most importantly the genetics of the thyroid tumors.
The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism. Fewer than 1% of all thyroid nodules are malignant (cancerous). Females are more likely to have thyroid cancer at a ratio of 3:1. The cause of thyroid cancer is unknown, but certain risk factors have been identified and include a family history of goiter, exposure to high levels of radiation, and certain hereditary syndromes
It is unclear whether the administration of radioiodine provides any benefit in low-risk cases after a complete surgical resection, and radioiodine is not recommended in patients with disease that is categorized as consisting of a tumor less than 1 cm in diameter and clinical stage N0. Therefore, radioiodine should be used with great care to minimize harm, administer the minimal amount of radioactivity, and involve the best tolerated methods.
The most common type of cancer arising in the kidney: Renal cell carcinoma(RCC)(also known as Hypernephroma or Grawitz tumor).
Renal cell carcinoma accounts for over 3% of all adult malignancies and has several histological subtypes.
Approximately 85% of kidney tumors are renal cell carcinoma, and approximately 70% of these have a Clear cell histology. Its diagnostic work-up, staging and management.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. TNM Staging
• Tumour
Tx: Primary cannot be assessed.
T0: No evidence of primary.
T1: Limited to thyroid, 2cm or less.
T1a:</=1cm
T1b:1cm </=2cm
T2:Limited to thyroid>2cm but <4cm.
T3:Limited to thyroid >4cm.
T4:Extending beyond the capsule any size.
T4a: moderately advanced
T4b:very advanced
3. • Nodes
Nx: Cannot be assessed.
N0: No regional node metastasis.
N1: Regional node metastasis.
N1a: level VI
N1b:any level
• Metastases
Mx: Cannot be assessed.
M0: No metastasis.
M1:Metastasis is present.
4. Stage under 45 yrs
I. Any T, any N,M0
II. Any T, any N,M1
III.
IVA.
IVB.
IVC
Over 45 yrs
T1,N0,M0
T2,N0,M0
T3,or T1,T2&N1a,M0
T4orT1,T2,T3,T4a&N1b,M0
T4b,anyN,M0
AnyT,anyN,M1
5. Papillary carcinoma thyroid
• Treatment of primary
A.Total thyroidectomy
-Treatment of choice.
-Entire thyroid gland is removed.
-Reasons:
a. Rich intrathyroidal lymphatic spread.
b. Multicentric origin.
6.
7. Procedure
]
• Horizontal anterior neck incision
• Create upper and lower flaps between
the platysma and strap muscles
• Divide vertically between the strap
muscles and anterior jugular veins
• Separate the strap muscles from the
thyroid gland
• Divide the middle thyroid vein
8. • Mobilize the superior pole of the thyroid lobe. Divide
the superior thyroid artery and vein close to the
thyroid gland (avoid injury to the external branch of
the superior laryngeal nerve and the superior
parathyroid gland)
• Identify the recurrent laryngeal nerve whenever
possible using the nerve monitoring device
• Identify the inferior parathyroid artery
• Divide the inferior thyroid artery and vein
9. • Separate the thyroid lobe and isthmus from the
trachea
• Repeat this process for the other thyroid lobe.
Remove the thyroid gland
• Reapproximate the strap muscles
• Reapproximate the platysma muscle
• Close the skin with a subcuticular stitch
10. -Advantages:
1. Easy to detect and treat residual and
metastatic diseases.
2. Eliminates contralteral occult cancer.
3. Eliminates resurgery.
4. Eliminates risk of recurrence, thus improving
survival.
.
11. After total thyroidectomy, thyroxine is not
given for a period of 4 weeks so that thyroid
remnants can be ablated with radioiodine.
Dose:30-100mCi.
12. B. Lobectomy
-Removal of one lobe and entire isthumus.
-Total thyroidectomy is recommended for
tumours greater than 2 cm and those with
nodal involvement or metastasis.
-So lobectomy can be done for the remainder.
13. Advantages of lobectomy:
a. No hormone replacement therapy.
b. No hypoparathyroidism.
c. Need not test thyroid function tests regularly.
14. • Treatment of secondaries in the lymph
nodes
Mostly central neck nodes are cleared. If
nodes are enlarged in the anterior triangle
they are dissected and removed along with fat
and fascia. This is called functional block
dissection.
Structures such as internal jugular vein,
sternomastoid muscle, accessory nerves are
not removed because lymph nodes are slow
growing and they rarely spread outside the
capsule of the node.
15. • Suppression of the TSH
This is an aspect in the postoperative period
because papillary carcinoma is a TSH
dependent tumour.
To prevent the patient developing
hypothyroidism in the post op period and to
suppress TSH, thyroxine 0.3 mg/day is given.
16. Patients who require regular radioiodine for
scanning and ablation should be given T3
because it acts quickly and can be stopped
and restarted quickly.
On the other hand, T4 has to be stopped
almost 30 days prior to scanning and ablation
rendering patients severely hypothyroid for 4
weeks. Dose:40-60micro gm/day.
17. Follicular carcinoma
• Treatment of primary
When a patient has enlarged thyroid gland
and scalp swelling, total thyroidectomy is the
treatment of choice.
Secondaries donot take up the radioisotope
in the presence of primary tumour. Hence
lobectomy or hemithyroidectomy should not
be done.
18. • Treatment of metastasis
After total thyroidectomy a whole body bone
scan is done to look for metastasis in the
bone.
The secondaries can be treated by oral
radioiodine therapy.
19. • Postoperative thyroxine
In the post op period patient should receive
thyroxine 0.3mg/day to suppress TSH and to
supplement thyroxine.
20. Anaplastic carcinoma
• Due to the gross local infiltration into the vital
structures in the neck such as common crotid
artery and trachea, the resectabilty rate is low.
• However rarely isthumus can be excised so as
to relieve compression of the trachea.
• Post operative radiotherapy is given as a
palliative treatment.
21. Medullary carcinoma of thyroid
• Total thyroidectomy with radical neck
dissection.
• The lymph nodes are treated by radical block
dissection because they are fast growing when
compared to papillary carcinoma.
• If there are multiple secondaries in the bone,
oral 131I has no role because this tumour
does not arise from thyroid cells. Only
palliative radiotherapy can be given.