Thyroid ECO

8/3/2019 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


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


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

Documents

Thyroid ECO