1. Treatment of thyroid nodules Depends on: –FNA cytological examination –Uptake of radioiodine –Size and patient preferences

2. Thyroid cancer conundra Thyroid nodules are common - >50% over 50y Histological appearances of cancer are present in 5-25% of thyroids at autopsy Clinical thyroid cancer is rare ~30 per 10 6 p.a. and death rates low (~6 per 10 6 p.a.)

3. Thyroid cancer TNM Grading T – primary tumor T0 – no palpable tumor T1 – single tumor confined to the gland T2 – multiple tumors confined to the gland T3 – tumor extending beyond the gland N – regional lymph nodes N0 – no palpable nodes N1 – moveable nodes on one side N2 – moveable bilateral nodes N3 – fixed nodes M – distant metastases M0 – none M1 – distant metastases Clinically, the dominant factor in governing prognosis in thyroid epithelial cell cancer is age. Others factors include size of primary tumor, degree of invasiveness, histological grade and the presence of metastases. Of these, all except histological grade are incorporated into the TNM classification.

4. Treatment of thyroid cancer Extent of surgery and radioiodine depends on: –Prognosis (i.e. TNM, age, histological grade) –Concentrating ability for 131 I –Preferences of both patient and medical staff General agreement that TSH should be suppressed Follow up by serum thyroglobulin measurement + 123 I scans