Papillary thyroid cancer is the most common type and requires total thyroidectomy, radioactive iodine therapy, and surveillance with calcitonin and thyroglobulin levels.
When evaluating patients with palpable thyroid nodules, assess for radiation exposure and family history, and use ultrasound and FNA biopsy for appropriate management.
Deep dives
Key Points and Insights on Thyroid Cancer
Papillary thyroid cancer is the most common type, affecting women and often associated with a history of radiation to the neck. It spreads to lymph nodes but rarely metastasizes hematogenously. Treatment involves total thyroidectomy, adjuvant radioactive iodine therapy, and surveillance with calcitonin and thyroglobulin levels. Follicular thyroid cancer spreads hematogenously and requires a total thyroidectomy. Medullary thyroid cancer arises from C cells, produces calcitonin, and is associated with germline mutations in the RET gene. Treatment involves total thyroidectomy with central and lateral node dissections.
Diagnosis and Workup of Thyroid Nodules
When evaluating patients with palpable thyroid nodules, assess for history of radiation exposure and family history of thyroid or endocrine malignancies. Use ultrasound to identify concerning features like hypoecogenicity, irregular margins, and microcalcifications. FNA biopsy is indicated for solid hypoechoic nodules greater than 10mm. The Bethesda criteria guide interpretation of FNA results, leading to appropriate management from repeat biopsy to total thyroidectomy.
Miscellaneous Facts and Surgical Considerations
Non-recurrent right laryngeal nerve is associated with an aberrant right subclavian artery. Ligating superior pole vessels close to the thyroid helps prevent injury to the superior laryngeal nerve during thyroidectomy. Serum markers monitored for thyroid cancer recurrence include thyroid globulin, calcitonin, and CEA. Total thyroidectomy is often performed for papillary, follicular, and medullary thyroid cancer to remove potential multifocal disease, facilitate post-op radioactive iodine therapy, and enable the use of thyroid globulin for surveillance.