35. Secondary toxic goiter

37. Retro sternal goiter

39. Recurrence (70% False recurrence)

42. Solitary thyroid nodule

49. Thyroid Malignancy 4 major types Papillary Folicular Anaplastic Medullary

50. Papillary Huge enlargement STN LN at the side of the neck Pressure manifestations Metastases lung and bone 10%

59. Follicular Bone metastases Recent rapid enlargement of pre exciting goitre STN

60. Follicular carcinoma

61. Change in long standing goitre

62. Anaplastic Carcinoma

64. Thyroid carcinoma Diagnosis Work-up fine needle aspiration most important in evaluating thyroid nodules preoperative diagnosis of most thyroid cancers helps to plan the extent of surgery Results categorized as: cancer follicular neoplasm (suspicious or indeterminate) insufficient (should be repeated, half of repeat specimens are adequate for diagnosis) benign

65. Thyroid carcinoma Diagnosis Work-up fine needle aspiration thyroid nodes requiring surgery decrease from 67% to 44% 85% of nodules called malignant on FNA will prove to be malignant only 3% of patients with benign citology will have thyroid cancer suspicious FNA samples – 50% of papillary and 20% of follicular are cancer 20% of nodules that yield an abundance of follicular cells with little or no colloid are minimally invasive follicular cancers

66. Thyroid carcinoma Diagnosis Work-up TSH measurement neck ultrasound: (size, borders, solid, cystic,uni/multicentri c, lymphnodes, guides FNA)

67. Thyroid carcinoma Diagnosis Work-up scintigraphy: capacity to concentrate radioisotope, cold nodules Are 15-20% malignant essential in postoperative follow-up (remnant tissue, metastatic tumors, WBS)

68. Thyroid carcinoma Diagnosis Work-up scintigraphy:

69. Thyroid carcinoma Diagnosis Work-up barium swallowing

70. Thyroid carcinoma Diagnosis Work-up computed tomography

71. Thyroid carcinoma Diagnosis Work-up computed tomography

72. Thyroid carcinoma Diagnosis Work-up magnetic resonance imaging

73. Thyroid carcinoma Diagnosis Work-up chest X-ray

74. Bone metastases pathological fracture

75. Brain metastases Treat like any other brain tumor: steroids, dextran, under close observation by a neurologist or neuro surgeon

76. I-123 Whole Body Scan

77. Tc-99m sestaMIBI

78. Standard Initial Treatment Usual Pathway Total Thyroidectomy Remove the thyroid with all cancerous tissue Radioactive Iodine Treatment Destroy any microscopic residual thyroid tissue Completely dependent on exogenous levothyroxine Without any functional thyroid tissue

79. Levothyroxine Therapy Thyroid Cancer Normalize TSH Prevent Symptoms of Hypothyroidism Suppress TSH Decreased Risk of Recurrence of Thyroid Cancer Without any functional thyroid tissue

80. Thyroid carcinoma Postoperative period Whole body scan

81. Thyroidectomy