This document discusses thyroid neoplasms and solitary thyroid nodules. It notes that while thyroid cancer is rare, thyroid nodules are relatively common. For any solitary thyroid nodule, malignancy must be excluded through investigation like fine needle aspiration cytology. Less than 10% of solitary nodules are malignant, rising to 40% in patients with a history of neck irradiation. The document outlines the presentation, investigations, treatment approaches, and pathological variants of different types of thyroid cancer.

1. THYROID NEOPLASMS &
SOLITARY THYROID
NODULE
PREPARED BY : DR. MOHAMED ELWARFALLI
BMC,BENGHAZI-LIBYA
DEPARTMENT OF SURGERY
APRIL 5, 2018

2. Thyroid cancer is rare about 1% of malignancies but
nodules in thyroid gland relatively is common.

3. Thyroid nodule;
A discrete swelling within the thyroid gland that is
palpable or radiologically distinct from surrounding
thyroid parenchyma.
It is may be symptomatic or be an incidental finding .
Clinical examination can detect asymptomatic thyroid
nodule in about 5% of the population.
This figure is increased to 25% using Ultrasound.

4. In any patient with a solitary thyroid nodule ,
MALIGNANCY needs to be excluded by investigation,
and fine needle aspiration cytology or needle core
biopsy is the first step in doing so.
Less than 10% of true solitary nodules are malignant ,
this rises to about 40% in patient who have undergone
previous neck irradiation.

5. Common causes of Solitary thyroid nodule;
BENIGN
Thyroiditis
Multinodular goiter
Simple/ Hgic cyst
Follicular adenoma
MALIGNANT
Primary
Papillary thyroid cancer
Follicular thyroid cancer
Hurthle cell cancer
Anaplastic thyroid cancer
Medullary thyroid cancer
Thyroid lymphoma
Secondary
Metastatic cancer

6. Thyroid Neoplasm :
Thyroid gland contains follicular & parafollicular ( C ) cells.
Tumors of the thyroid gland can be classified as :
1. Tumors arising from follicular epithelium:
BENIGN Follicular adenoma.
MALIGNANT Differentiated Papillary carcinoma 80%
Follicular carcinoma 10%
Hurthle cell carcinoma 4%
Undifferentiated Anaplastic carcinoma 1%
2.Tumors from parafollicular ep. : Medullary carcinoma 5%
3.Tumors from lymphoid elements: Malignant lymphoma.
4.Rarely the thyroid gland infiltrated by metastatic deposits or by local
infiltration from a nearby lesion.

7. Presentation;
Benign and malignant thyroid nodules usually present as 1.
Neck LUMP
2. Painful swelling : *Hge. *Thyroiditis. *Malignancy.
3. Toxic manifestation in toxic nodules.
4. Criteria of malignancy in malignant nodules.
Other clinical manifestations are :
Neck discomfort , difficulty in swallowing or breathing ,
change in voice , History of rapid growth , cervical lymph
nodes.

8. Findings that raise suspicion of malignancy
in a solitary nodule:
1.History of previous irradiation.
2.Young and elderly patients.
3.Male sex.
4.F/H of MEN2.
5.Recent onset , and rapid growth.
6.Painful , Hard , Irregular nodule with limited mobility.
7.Local invasion or lymphatic , blood borne metastasis.

9. Clinical examination;
A complete physical examination is necessary , with
emphasis on the inspection and palpation of the neck ,
including the thyroid and the lymph node compartments in
the neck.

10. Investigations;
1. Suspicion of TOXICITY , Thyroid function tests are
performed.
2. Calcium , calcitonin , thyroglobulin, Autoantibody status
should be checked.
3. Thyroid isotope scan.
4.Ultrasound ; differentiate b/w a cyst and solid nodule.
5. FNAC ; simple, fast, inexpensive but can’t differentiate b/w
follicular adenoma and follicular carcinoma.
6. True cut needle biopsy.
7. Excision biopsy ; the surest method of diagnosis is to do
lobectomy of the affected side and then frozen section.

13. Treatment scheme :
a. Multiple : Subtotal
thyroidectomy.
b. Solitary :
1. CYSTIC : aspiration = Simple
cyst OR suspicion of
Malignancy ( ttt accordingly ).
2. Solid : Thyroid scan =
-HOT = Toxic nodule.
-Warm = adenoma (hem-
thyroidectomy & biobsy)
-COLD = biobsy , Benign (
hemi-thyroidectomy ) .
Malignant ( treat
accordingly ).

14. Pathological variants of malignant
neoplasms :
Papillary thyroid carcinoma ;
-Commonest form thyroid carcinoma.
-Children & young adult.
-Psammoma bodies
-Lymphatic spread
-Positive prognosis
-Pulmonary metastases.
Treatment :
Total thyroidectomy.
Post operative L-thyroxine 0.2mg/day.

15. Follicular thyroid carcinoma ;
-Middle age female
-FNA can’t diagnose cancer
-Capsular or vascular invasion
-Mainly blood spread
-Favorable prognosis
Treatment:
Total thyroidectomy.
Post op. L-thyroxine.

16. Anaplastic carcinoma ;
-Uncommon 1% .
-Elderly.
-Aggressive , prognosis poor ( most patients die within 1 year
-Spindle cells , Giant cells
-Mainly direct invasion, Lymphatic or blood spread.
Treatment:
Small tumor : Total thyroidectomy + XRT/Chemo
Large tumor : Debulking surgery and tracheostomy,
XRT/Chemo.

17. Medullary carcinoma ;
-Rare tumor.
-Sporadic or familial (children and young adult).
-MEN2, secrete calcitonin.
-Hyaline stroma contain amyloid material.
-Lymphatic/Blood spread.
Treatment :
Total thyroidectomy and L.N resection.

18. Lymphoma :
-Arise in a pre-existing longstanding Hashimoto’s thyroiditis.
-Elderly woman.
Treatment:
XRT / Chemo.