1. Solitary thyroid nodule Hystory Low dose radiation Family hystory Physical exam

2. Diagnostic test FNA FNA 65% BENIGN 65% BENIGN 20%SUSPICIOUS 20%SUSPICIOUS 5%MALIGNANT 5%MALIGNANT 15%NONDIAGNOSTIC 15%NONDIAGNOSTIC 1%FULSE POSITIVE 1%FULSE POSITIVE 3%FULSE NEGATIVE 3%FULSE NEGATIVE

3. LABORATORY STUDIES EUTHYROID EUTHYROID TSH TSH TG TG CALCITONIN CALCITONIN CEA CEA

4. IMAGING SONOGRAPHY SONOGRAPHY CT SCAN CT SCAN MRI MRI THYROID SCAN THYROID SCAN

5. MANABNGEMENT MALIGNANT THYROIDECTOMY MALIGNANT THYROIDECTOMY CYST aspiration CYST aspiration

6. PAPILARY THYROID CANCER 80% OF THYROID CA in iodine sufficient area and children and radiation exposed patients 80% OF THYROID CA in iodine sufficient area and children and radiation exposed patients female:male ratio 2/1 female:male ratio 2/1 Age30-40 Age30-40 Euthyroid Euthyroid Lymphatic metastasis Lymphatic metastasis Metastasis to long bone liver brain Metastasis to long bone liver brain

7. pathology Section Section Psommama bodies Psommama bodies Multifocl 85% Multifocl 85%

8. Prognostic indicator 95% 10years sur 95% 10years sur Prognostic factors Prognostic factors Age Age Hystologic grade Hystologic grade Tumor size Tumor size Differentiation Differentiation External thyroid invation& metastasis External thyroid invation& metastasis

9. Surgical treatment high risk patient = total or near total thyroidectomy high risk patient = total or near total thyroidectomy Minimaly ptc = lobectomy isthmectomy Minimaly ptc = lobectomy isthmectomy If no angioinvation no mutifocal no positive margin In low risk patient type of surgery is cotraversy

10. Type of surgery in low risk Total or near total Total or near total Lobectomy isthmectomy Lobectomy isthmectomy

11. Follicular carcinoma 10% of thyroid cancer 10% of thyroid cancer Often in iodine deficiency area Often in iodine deficiency area F:m ratio = 3/1 F:m ratio = 3/1 50 years 50 years Pain is rare Pain is rare Lymphadenopathy is rare5% Lymphadenopathy is rare5% 1% hot nodule 1% hot nodule

12. FNA In follicular is not diagnostic In follicular is not diagnostic

13. pathology Vascular and capsular invation Vascular and capsular invation Minimally invasive tumor Minimally invasive tumor

14. Surgical treatment &prognosis Minimally invasive=lobectomy Minimally invasive=lobectomy frankely invasive ca =total thyroidectomy frankely invasive ca =total thyroidectomy Patient with angioinvation=total thyroidectomy Patient with angioinvation=total thyroidectomy Node disectoin if lymph node is + not prophylaxy Node disectoin if lymph node is + not prophylaxy

15. Hurthle cell ca 3%of thyroid ca 3%of thyroid ca Sub type of follicular Sub type of follicular Fna same as follicular Fna same as follicular Multifocal and multy center 30%rai uptake no or low Multifocal and multy center 30%rai uptake no or low Local lymph node 30% treatment same as ftc hurthle cell adenma=lobectomy hurthle cellca total thyroidectomy Local lymph node 30% treatment same as ftc hurthle cell adenma=lobectomy hurthle cellca total thyroidectomy Same as mtc routine central node disection Same as mtc routine central node disection Lateral node+=MND Lateral node+=MND RAI scan and ablation not effective RAI scan and ablation not effective

16. Post opperative manangment of differentiated thyroid ca Thyroid hormone Thyroid hormone TG TG SONO CT MRI of neck must be done in high risk patient SONO CT MRI of neck must be done in high risk patient Radioiodine therapy Radioiodine therapy External beam radiotherapy& chemotherapy External beam radiotherapy& chemotherapy

17. Medullary thyroid cancer 5% of thyroid ca 5% of thyroid ca C-cell C-cell MTC is often sporadically 25% is familial MTC is often sporadically 25% is familial 15-20% lymphadenopathy at the time of diagnosis 15-20% lymphadenopathy at the time of diagnosis Pain is common Pain is common Dysphagea and dysnea and dysphonea may be Dysphagea and dysnea and dysphonea may be Metastas to liver bone(osteoblastic) lung Metastas to liver bone(osteoblastic) lung M f:m ratio1/1/2 f:m ratio1/1/2 50 — 6o 50 — 6o Calcitonin cea serotonin pr e2 f2alfa Calcitonin cea serotonin pr e2 f2alfa

18. MTC DIARHEA DIARHEA Cushing.s syn ectopic ACTH Cushing.s syn ectopic ACTH

19. PATHOLOGY IN SPORADIC 80%UNILATERAL IN SPORADIC 80%UNILATERAL IN FAMILIAL TYPE 90%BILATERAL AND MULTICENTERAL IN FAMILIAL TYPE 90%BILATERAL AND MULTICENTERAL AMYLOID IS DIAGNOSTIC AMYLOID IS DIAGNOSTIC

20. DIAGNOSIS HYSTORY HYSTORY PHYSICAL EXAME PHYSICAL EXAME SERUM CALCITONIN AND CEA SERUM CALCITONIN AND CEA FNA FNA

21. TREATMENT Gold standard therapy is total thyroidectomy if may be becouse Gold standard therapy is total thyroidectomy if may be becouse Bilateral central neck node disection Bilateral central neck node disection MND in node positive and tumor greater than MND in node positive and tumor greater than 1/5 cm 1/5 cm External radiotherapy is debate residual tumor unresectable recurence External radiotherapy is debate residual tumor unresectable recurence RF or radiofrequency RF or radiofrequency

22. Anaplastic ca 1% 1% Women Women 70-80 70-80 Rapidly enlarge neck mass Rapidly enlarge neck mass Dysnea dysphonea dysphagea are common Dysnea dysphonea dysphagea are common Fixed may be ulcerated often lymph node possitive Fixed may be ulcerated often lymph node possitive

23. Diagnosis and treatment FNA occasionally incisional biopsy FNA occasionally incisional biopsy Poor prognosis Poor prognosis

24. limphoma Non-hdgkin b-cell type Non-hdgkin b-cell type Most commonly from chronic lymphocytic thyroiditis Most commonly from chronic lymphocytic thyroiditis Symptom same anaplastic ca

25. diagnosis Often with FNA Often with FNA Needle core biopsy or open biopsy may be needed Needle core biopsy or open biopsy may be needed

26. treatment Chemothrapy Chemothrapy Radiotherapy Radiotherapy thyroidectomy thyroidectomy

27. Metastatic ca Is rare Is rare Kidney Kidney Breast Breast Lung Lung melanoma melanoma

28. Complication of thyroid surgery RLN INJERY RLN INJERY EXTERNAL BERANCH OF SUP LARING N INJERY EXTERNAL BERANCH OF SUP LARING N INJERY NECK SYMPATHETIC NERVE INJURY NECK SYMPATHETIC NERVE INJURY HYPOCALCEMIA AND HYPOPARATHYROIDISM HYPOCALCEMIA AND HYPOPARATHYROIDISM HEMATOMA HEMORHAGE HEMATOMA HEMORHAGE SEROMA SEROMA CELULITIS INFECTION CELULITIS INFECTION JUGULAR VEIN AND CAROTID AND ESOPHGUSE INJERY IS RARE JUGULAR VEIN AND CAROTID AND ESOPHGUSE INJERY IS RARE

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