Thyroid carcinoma

Initial Diagnostic Approach
Nodularity of the thyroid gland is common, and palpable nodules are found more often in women than in men. The main focus of the initial evaluation is to exclude malignancy (Table 116.2).
As a basic diagnostic step, all patients with thyroid nodularity should have their thyroid function assessed with a set of function tests, particularly TSH. Ultrasound has become the gold standard for evaluation of a thyroid nodule, not only for clarifying the anatomy but also for obtaining an accurate FNA result.
Thyroidectomy: Surgical Techniques
COMPLICATIONS SURGERY FOR THYROID NODULES

* Hemorrhage and hematoma
* Seroma
* Infection
* Recurrent laryngeal nerve injury
* Superior laryngeal nerve injury
* Hypocalcemia
* Airway obstruction
* Others: pneumomediastinum, pneumothorax, hemothorax, and chyle leak



The most important prognostic parameters used include age, extrathyroidal extension, sex, size of lesion, and presence of distant metastasis.

The lymph nodes most commonly involved with thyroid metastasis are the paratracheal nodes. Following these, the metastasis pattern is one involving the level IV (52%), followed by the levels III, V, and II (45%, 33%, and 30%, respectively).
Medullary Thyroid Carcinoma
MTC differs fundamentally from thyrocyte carcinomas, not only in embryology and microscopic anatomy but also in function, tumor biology, pathogenesis, and genetics. MTC can be diagnosed at a preclinical stage by a specific secretory product, calcitonin. The hereditary variant of MTC can be identified unequivocally in about 95% of patients by genetic analysis. MTC cannot be treated with radioiodine and no multimodal treatment protocol has been proven effective in advanced and/or metastatic MTC.
Diagnosis
Most commonly, MTC is encountered in the lateral upper two thirds of the thyroid gland because C-cell concentrations are highest in this area.

Technorati Tags: thyroid, carcinoma, nodul, lymph nodes