39. Thyroid tumors. Inflammatory disorders of the thyroid gland (unfinished)

Page created on October 11, 2021. Last updated on October 27, 2021 at 17:00

Thyroid tumours

Introduction

For introduction, types, and pathology, see the corresponding pathology 2 topic.

Clinical features

Thyroid tumours usually present as a thyroid nodule found during physical examination or incidentally during imaging.

Thyroid cancer may present as a fast-growing nodule which is hard and fixed. It’s especially suspicious in patients with previous external radiation of the neck. In severe cases it may cause hoarseness or stridor, and in case of metastasis enlarged lymph nodes may be found on the neck.

Diagnosis and evaluation

When a new thyroid nodule is found, TSH should be measured, and the nodule should be examined with ultrasound. If the ultrasound shows features suspicious for malignancy, a fine needle aspiration biopsy (FNAB) is usually performed to determine the dignity, if the nodule is over a certain size. If the nodule is too small for FNAB, it’s monitored regularly.

If TSH is low, thyroid scintigraphy is performed to look for whether the nodule is hot (produces hormones) or cold (doesn’t). A single hot nodule is a toxic adenoma, while multiple hot nodules is a toxic multinodular goitre. Hot nodules are rarely malignant.

Serum calcitonin is a specific tumor marker for medullary type thyroid cancer.

Treatment

Hot nodules are treated with radioiodine therapy or surgical removal. Compensated toxic adenoma is managed with observation only.

Malignant cold nodules are treated with surgery. Benign cold nodules are treated with observation if < 3 cm, and surgery if > 3 cm.

Thyroid cancer is treated with total thyroidectomy with or without neck dissection. For well-differentiated cancers, radioactive iodine ablation and TSH suppression therapy are used after the surgery. TSH is a growth factor and so suppression of it prevents tumour recurrence. However, poorly differentiated cancers respond to neither radioactive iodine ablation nor TSH suppression. Instead, poorly differentiated cancers are treated with adjuvant radiation and/or chemotherapy.

After total thyroidectomy, thyroid hormones must be substituted for life.

Inflammatory disorders of the thyroid gland

To be finished


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42. Hypoparathyroidism. Hyperparathyroidism

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Internal medicine

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