Download - Thyroid ECO
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SYMPTOMS
Hyperactivity, irritability
Heat intolerance Palpitations
Fatigue and weakness
Weight loss despite
increased appetite Diarrhea
Polyuria
Oligomenorrhea, loss oflibido
SIGNS
Tachycardia
Tremor Goiter
Warm, moist skin
Muscle weakness
Lid retraction or lag Gynecomastia
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TREATMENT Medical
Antithyroid drugs Beta blocker
Radioactive IodineTherapy 131I
Surgical SubtotalThyroidectomy
BilateralSubtotal
Hartley-Dunhill
Total or NearTotalThyroidectomy
Lobectomy, isthmusectomy
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Graves Disease
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Toxic Multinodular Goiter
ToxicAdenoma (Plummers Disease)
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SYMPTOMS
Tiredness, weakness
Dry skin Feeling cold
Hair loss
Difficulty concentrating
Constipation Weight gain with poor
appetite
SIGNS
Dry coarse skin, cool
peripheral extremities Puffy face, hands, feet
(myxedema)
Diffuse alopecia
Bradycardia Peripheral edema
Delayed tendon reflexrelaxation
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AutoimmuneThyroid Disease
Post-Thyroidectomy
Post-radioiodineTherapy Secondary orTertiary Cause
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Autoimmune
Lymphocytic (Hashimotos )Thyroiditis
Infection Viral (De Quervains)Thyroiditis
Physical
Neck radiation
Idiopathic
Fibrous (Riedels)Thyroiditis
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DIAGNOSTICTESTS
Thyroid FunctionTest
RAIUScan FNABiopsy
CTScan
MANA
GE
MENT
Medical
Surgical
SubtotalThyroidectomy
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DIAGNOSTICTESTS FNABiopsy
Laboratory TSH
SerumTg
Calcitonin
Imaging Ultrasound
CT, MRI
Thyroid Scan
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MANAGEMENT
Simple Cysts
Aspiration
ColloidNodule
Serial Ultrasound
SerialTg
FNA Biopsy
Thyroidectomy
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Age is an important prognostic factor
20-45 years old
More common in women than in men, butworse prognosis in men
History of head and neck irradiation
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Minimal or Occult/Microcarcinoma tumors
Intrathyroidal tumors
Extrathyroidal tumors
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Factors Score
DistantMetastasisDid the tumor spread to other parts of
the body outside of the region of the
neck?
Yes = 3No = 0
Age at the time the tumor was found Less than 39 years = 3.1Over 40 = 0.08 x age
InvasionDid the surgeon see that the tumor
extended beyond the thyroid into otherregions of the neck?
Yes = 1No = 0
Completeness of resectionWere there parts of the tumor that the
surgeon was unable to remove?
Yes = 1No = 0
Size of the tumor
Measured by the pathologist
0.3cm x size in cm
20-
YearSurvivalRateaccordingto MACIS ScoreMACISScore
8.0
20 yrsurvival
99% 89% 56% 24%
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Stage Age 45 Local
RecurrenceDistal
Recurrence
Mortality
I AnyTAnyNM0
T1No M0 5.5% 2.8% 1.8%
II AnyTAnyNM1
T2N0 M0T3N0 M0
7% 7% 11.6%
III - T4N0 M0AnyTAnyNM0
27% 13.5% 37.8%
IV - AnyTAnyNM1
10% 100% 90%
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Low Risk1.8%mortalityrate
HighRisk46% mortalityrate
Men under 41 and women under 51without distant metastaes
All patients with distant metastases
All men over 41 and women over 51 with:
Intra-thyroidal papillary cancer (papillarycancer confined present only within the
thyroid gland) ORFollicular cancer tumor with minor
capsular involvement (tumor slightlyextends into the capsule which surrounds
it)AND
Primary tumor less than 5cm in diameterAND
No distant metastases
All men over 41 and women over 51 with:
Extra-thyroidal papillary cancer (extendsbeyond the thyroid gland) OR
Follicular cancer tumor with majorcapsular involvement (the tumor extends
significantly into the capsule whichsurrounds it)AND/OR
Primary cancer is 5cm in diameter orlarger, regardless of the extent of thedisease
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MANAGEMENT
Lobectomy, isthmusectomy
Total or near total thyroidectomy Modified radical or functional neck dissection
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MANAGEMENT
Lobectomy
TotalThyroidectomy 131I
Neck dissection uncommon
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MANAGEMENT
Lobectomy, isthmusectomy
Total thyroidecotmy Modified radical neck dissection
131I
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Thyroid hormone
Thyroglobulin measurement
Radioiodine therapy External beam radiotherapy and
chemotherapy
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Thyroid hormone To ensure that the patient remains euthyroid
0.1 U/L in low-risk patients, or less than 0.1 U/mL in high-riskpatients
Thyroglobulin Measurement High value is suggestive of metastatic disease or
persistent thyroid tissue
below 2 ng/mL when the patient is takingT4, andbelow 5 ng/mL when the patient is hypothyroid
Thyroglobulin and anti-TgAb should be measured at6-month intervals
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RadioiodineTherapy
With any significant uptake, a therapeutic dose of131I
should be administered (low-risk patients: 30 to 100 mCi; high-risk patients:
100 to 200mCi)
External Beam Radiotherapy and Chemotherapy
To control unresectable, locally invasive, or recurrentdisease and to treat metastases in bones
Adriamycin andTaxol are the most frequently used
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DIAGNOSITCTESTS Serum Calcitonin
CEA FNA cytology
MANAGEMENT Total thyroidectomy
Modified radical neck dissection 131I not effective
Parathyroidectomy
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MANAGEMENT
Thyroidectomy
Combined chemotherapy and radiotherapy Tracheostomy
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MANAGEMENT
Chemotherapy (CHOP)
Cyclophosphamide, doxorubicin, vincristine, prednisone Radiotherapy
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Schwartz, 8th edition
Harrisons, 17th edition
Sabiston, 18th edition
http://www.cumc.columbia.edu/dept/thyroid/staging.html