The document discusses various types of thyroid tumors including cancer. It describes the normal anatomy and microscopic picture of the thyroid gland. The primary types of thyroid cancer are papillary, follicular, medullary, and anaplastic originating from the follicular epithelium or parafollicular cells. Risk factors include radiation exposure, family history, iodine deficiency, and thyroiditis. Evaluation involves history, examination, FNAC, ultrasound, and radiological investigations. Treatment depends on cancer type and involves surgery, radioactive iodine, and thyroxine therapy. Prognosis depends on age, tumor size and spread.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
A supercool powerpoint about thyroid cancer that is very hard to understand unless I am speaking to you and filling in the blanks so check out my blog and look for a related post:
http://m4tt5-b10-bl0g-2o1o.blogspot.com/
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
A supercool powerpoint about thyroid cancer that is very hard to understand unless I am speaking to you and filling in the blanks so check out my blog and look for a related post:
http://m4tt5-b10-bl0g-2o1o.blogspot.com/
Differentiated Thyroid cancer American cancer guidelines. Risk grouping and radioactive Iodine Ablation Low dose vs High dose RAI Ablation. Initial assessment of a thyroid nodule
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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5. THE CAUSES:
Radiationexposure to thyroid gland in
child hood
Schneider AB etal,Radation-induced endocrine tumor Cancer
treat res 1997;89:141
Family hx. : a 4 to 10 fold increased risk
of well differentiated thyroid cancer in
1st degree relatives with this neoplasia
Galanti MR et al, risk of papillary and follicular thyroid carcinoma , Br J
Cancer 1997;75:451
6. THE CAUSES:
Iodine:Iodine-deficient diets may
lead to increase the TSH level and
considered goitrogenic
Thyroiditis:
(Hashimoto's Disease)
may develop into a form of cancer
called lymphoma.
8. EVALUATION OF THYROID TUMOR:
History:
Age and Gender
Rapid increase in size, dyspnea,
dysphagia and hoarseness of voice
Family Hx. Of thyroid cancer
Hx. Of irradiation
On Examination:
Firmness, Mobility, Size and adherence
to surrounding structures
Presence of lymphadenopathy
9. INVESTIGATIONS:
FNAC:
The accuracy cytological diagnosis
from FNA ranges from 70% to 97%
and highly dependent on the skill of
the physician and the
cytopathologist interpreting it.
Burch HB. Endocrinol Metab Clin North Am
1995;24:663
10. INVESTIGATIONS:
US:
For the presence of malignant assosciations
Microcalcification
Irregular margins
Hypervascularity
Extra glandular extension
Frates MC et al, Doppler sonography aid in the predfcation of
malignancy of predication of thyroid of nodules J US Med 2003;22:127
11. INVESTIGATIONS:
US guided FNA :
Decrease the nondiagnostic specimen
Increase the sensitivity and specificity
Avoiding vascular structures
Carmeci C et al, US guided FNA of thyroid masses
1998;8:283
12. INVESTIGATIONS:
Radionuclide Scan:
To determine the functional status of the
nodule
Hypofunctional “cold nodule”ule”
Serum Calcitonin level:
Routine measurement of calcitonin level
advocated by some authors to Dx. Medullary
cancer is unknown
13. Ten most common types of Cancer among
Adult Saudis by Sex, 2001
17. CLINICAL PRESENTATION:
Incidental
as a small occult tumor <1cm (papillary microcarcinoma)
Mass in the Neck
the commonest way papillary cancer presents
Glands in the Side of the Neck
The spread to local glands (sometimes called
erroneously quot;lateral aberrant thyroidquot;).
Distant Spread
Spread to lungs or bone is very rare but when it
occurs unlike most other cancers, cure is possible.
18. THE FOLLICULAR CANCER:
It is unifocal, thickly encapsulated and
shows invasion of both capsule and
blood vessels
Spread by the blood stream and rarely
through lymphatic
It is unusual tumor (5 -10%)
19. CLINICAL PRESENTATION:
As a single lump in the thyroid:
This is the common mode of presentation.
As pain in a bone or a spontaneous fracture:
in case of metastases to bone through the
blood stream
20.
21. THE PROGNOSIS IN DIFFERENTIATED
THYROID CARCINOMA:
Thetwo dominant factors are the age at the
diagnosis and the presence of distant
metastases.
Mazzafferi El etal, Long term impact of initial surgical and medical therapy on thyroid
cancer .Am J Med 1994;97:418
Recentseveral scoring systems based on
multifactorial analysis of risk factors have been
advise
22.
23. Low risk High risk
Patient age < 45 y > 45 y
Tumor size < 4.0 cm > 4.0 cm
Extrathyoidal absent present
extension
Distant absent present
metastases
High tumor absent present
grade
24. THE TREATMENT OF WELL
DIFFERENTIATED THYROID CANCER:
It Consists of a three- pronged attack :
Thyroid Surgery
Radioactive iodine therapy
Drug - Thyroxine therapy
25. SURGERY:
Acceptable surgical procedure to remove
thyroid tumor include
Ipsilateral lobectomy
Near total thyroidectomy
Total thyroidectomy
The recent American Thyroid Association
Guide lines recommended for more aggressive
(total thyroidectomy ) for well differentiated
thyroid carcinonoma
Cooper DS et al. Management guidelines for thyroid nodules
,Thyroid2006;19:109
26.
27. SURGERY :
With a 20-year follow up the incidence of
local recurrence with unilateral resection was
(14%),whereas, for bilateral resection it was
(2%) Brauckhoff M, et al surgery 2006;140:953
Forgross involvement of trachea or
esophagus resection of these structures with
reconstruction
Cooper DS et al. Management guidelines for
thyroid nodules , Thyroid2006;19:109
28. RADIOIODINE THERAPY:
The Indications:
1.After Surgery to destroy any residual thyroid
cancer cells or residual normal thyroid tissue.
2.To treat thyroid cancer that has spread to
the lymph nodes, lungs or bones.
3.To treat thyroid cancer recurrence after
initial treatment by surgery or previous
radioactive iodine or both.
29. RADIOIODINE THERAPY:
Recent American thyroid association guide
lines recommended radioiodine ablation for:
Pt. with stage III or IV disease
All Pt. with stage II disease <45 yrs or
> 45 yrs
Selected Pt. with stage I disease those
with:
large tumor ( >1.5 cm )
multifocality
residual disease
nodal metastasis
Cooper DS et al . Management guide line
for patient with thyroid nodules and cancer
. Thyroid 2006;16:109
30. THYROXIN THERAPY :
Recent meta-analysis supported the
efficacy of TSH suppression in
preventing adverse clinical effect
High risk pt. are maintained at TSH level
below 0.1 mU/ L
Low risk pt. TSH level at or below the
normal range (0.1- 0.5 mU/ L)
McGriff NJ, et al. effect of thyroid hormone suppression therapy
on thyroid cancer. Ann Med 2002;34:557
31. THYROXIN THERAPY :
Thedegree of thyroid suppression is
dictated by balancing the risk of
recurrent thyroid cancer and
subclinical thyrotoxicosis
particularly the cardiovascular risks
34. Looking at BRAF mutation detection
of thyroid cancer in FNAB samples
demonstrate a 100% specificity and
sensitivity in cases of PTC carrying
BRAF mutation.
Chung KW,etal. Detection of BRAF in FNA
specimen of tyroid nodule.Clin Endocri 2006;65:660-6
35. MEDULLARY THYROID CANCER:
These are tumors of parafollicular (C
cells), which produce a hormone called
calcitonin
Types of MTC :
Sporadic MTC
Familial MTC
MEN 2A
MEN 2B
Familial Non- MEN
36.
37. CLINCAL PRESENTATION:
SporadicMTC:
asymptomatic thyroid mass
FamilialMTC :
screening stimulation test for
calcitonin or with molecular analysis
( detection of RET gene mutation)
38. TREATMENT OF SPORADIC MTC:
Ccells do not concentrate
iodine so radioactive iodine is of
no value in the management
39. Surgery is the only definitive
therapy of MTC:
Total thyroidectomy
Central node dissection
Ipsilateral modified radical neck
dissection
41. TREATMENT OF FAMILIAL MTC:
Based on the genetic test for the
mutation of RET gene
Since different mutations in the
RET gene are associated with
variable disease aggressiveness
this leading to individualized
treatment of pt. with inherited MTC
42. MEN2A AND FMTC RX. :
Prophylactic thyroidectomy at age 5 to
6 years
Moley JF. Medullary thyroid carcinoma.
Curr Treat Options Onco 2003;4:339
44. ANAPLASTIC CANCER OF THE THYROID:
It is a very aggressive tumor with a poor
prognosis
A female to male ratio 1.5:1 and a mean age
is 67 years
It is commonest in areas of endemic goiter
where there is chronic iodine deficiency.
ATC commonly related to prior diagnosis of
well differentiated thyroid cancer
Mclver B et al, Anaplastic Thyroid Carcinoma
surgery 2001;130;1028
45. CLINICAL PRESENTATION:
a long-standing goiter that suddenly
increases in size.
Local invasion lead to obstructive
symptoms, hemoptysis, dysphagia and
hoarseness
At the time of Dx. 25 to 50 % of Pt. have
synchronous pulmonary metastases
Mclver B et al, Anaplastic Thyroid Carcinoma
.Surgery 2001;130;1028
46. A woman with anaplastic A CT scan showing anaplastic
cancer of the thyroid cancer of the thyroid
47. SURGICAL TREATMENT OF ATC:
Inthe majority of cases surgery is
limited to an open biopsy to exclude
lymphoma
Mclver B et al, Anaplastic Thyroid Carcinoma
.Surgery 2001;130;1028
48. RADIOTHERAPY AND CHEMOTHERAP:
External beam radiotherapy (EBRR) as
been used with limited success to
treat locally recurrent ATC
Doxorubicin is the single most
effective chemotherapeutic for ATC
Ain KB etal, treatment of anaplastic carcinoma
of thyroid. (CATCHIT) Group. Tyroid
2000;10;587
49. THYROID LYMPHOMA:
Thyroid lymphoma is relatively rare
disease constituting <1% of all
lymphoma and accounting for 2% of
extranodal non- Hodgkin’s lymphoma
Green LD et al, anaplastic thyroid cancer
and 1ry thyroid lymphoma. J Surg Oncol
2006;94:725
Female: Male ratio from 3:1 up to 8:1
Median age is seventh decade of life
50. CLINICAL PRESENTATION:
Local invasion : hoarseness, dyspnea
with stridor, or dysphagia
Hypothyroidism in case of Autoimmune
thyroiditis or Hashimoto’s thyroiditis
51. A 70 Y. old lady with diffuse
large B cell lymphoma
52. TREATMENT :
Primarytreatment should be EBRT
combined with Chemotherapy
regimen based on histopathological
subtype of lymphoma
Green LD et al, anaplastic thyroid
cancer and 1ry thyroid lymphoma. J
Surg Oncol 2006;94:725
53. TREATMENT :
Primarytreatment should be EBRT
combined with Chemotherapy
regimen based on histopathological
subtype of lymphoma
Green LD et al, anaplastic thyroid
cancer and 1ry thyroid lymphoma. J
Surg Oncol 2006;94:725