INVESTIGATION AND MANAGEMENT Ca THYROID

SHAJAHAN.C ROLL NO:157

 TFT

HIGH TSH IN PAPILLARY CA. SERUM TG FOLLOW UP CANCER SERUM CALCITONIN MTC CEA MTC

FNAC Easy to perform, less morbidity. Highly sensitive in pap ca & its nodal spread. Benign vs malignant Disadvantages less tissue for diagnosis limit in differentiation of certain types of thyroid cancers Follicular adenoma vs. carcinoma

INCISIONAL BIOPSY Anaplastic Lymphoma ENT CONSULTATION RLN

IMAGING
X RAY

RETROSTERNAL,TRACHEA,PULM METS. USG HYPOECHOGENIC LOSS OF PERIPHERAL HALO MICROCALCIFICATION Cx LNE IRREGULAR CT and MRI CAN ASSES SIZE, RETROSTERNAL EXTENSION, POSITION AND RELATION TO THE SUROUNDING STR. RAI SCAN TO DIFFERENTIATE HOT FROM COLD NODULES. 15% to 20% OF COLD

Prognostic Risk Classification for Patients with Well-Differentiated Thyroid Cancer (AMES or AGES)
Age
Sex Extent

Low Risk <40 years Female

No local extension,

High Risk >40 years Male

Capsular invasion,

intrathyroid, no caps invasion

extra thyroidal extension

Metastasis Size Grade

None <2 cm Well diff

Regional/distant >4 cm Poorly diff

HIGH RISK FOR DEATH-40% IN 20 YRS LOW RISK FOR DEATH-1% IN 20 YRS 80% IN LOW RISK PROGNOSIS OF MCA SPORADIC,MEN2-AGGRASSIVE

THYROID OPERATIONS
Total thyroidectomy =

2 total lobectomy + isthmusectomy Subtotal thyroidectomy = 2 subtotal lobectomy + isthmusectomy Near-total thyroidectomy = Total lobectomy + subtotal lobectomy + isthemusectomy Lobectomy =Total lobectomy+isthmusectomy

MANAGEMENT
FNAC-PAP CA

TOTAL THYROIDECTOMY+CENTRAL COMPARTMENT DISSECTION(IF CLINICALLY NEGATIVE NODE)OR FUNCTIONAL NECK DISSECTION(INDICATIONSLNE,NODE BY IMAGING,BIOPSY PROVEN METS NODE,FROZEN SECTN NODE POSITIVITY DURING Sx)

 FNAC-FOLLICULAR NEOPLASM

HEMITHYROIDECTOMY&SPECIMEN SENT FOR HPR. HPR RESULT FOLL ADENOMA-ROUTINE FOLLOW UP FOLL CA-COMPLTN THYROIDECTOMY WITH IN 48 HRS OR AFTER 6 WKS.

 MEDULLARY CA

TOTAL THYROIDECTOMY+CENTRAL COMP(CLIN NEG LN) OR MRND(IF INDICATION) A GENETIC SCREENING IS MUST. IF PHECHROMOCYTOMAADRENALECTOMY 1ST. OCTEROTIDE.

 ANAPLASTIC
TRACHEOSTOMY&ISTHMECTOMY+RT+CT(ADRI AMYCIN)

LYMPHOMA
CT

STEPS IN Sx
REVERSE TRENDELENBERG POSITION

GA
INCISION-KOCHERS COLLAR INCISION

 FLAPS RAISED,JOLLES SELF RETAINING RET.

VERTICAL INCISION ON INVESTING LAYER.

PULL ASIDE THE STRAP MUSCLES. VERTICAL INCISION ON PRETRACHEAL

FASCIA. MIDDLE THY VEIN

 LIGATE & CUT SUPERIOR PEDICLE,CLOSE TO

GLAND.

 LIGATE&CUT INF THY PEDICLE,AWAY FROM

GLAND. DO SAME ON OPPOSITE SIDE. CLOSE ALL LAYERS. PLACE SUCTION.

FOLLOW UP IN DTC
SUPPRESSIVE THYROXINE-300mic gm.

LOOK FOR THYROID REMNANT BY RAD

IODINE SCAN. TSH ATLEAST 30mIU/L ELTROXINE WITHDRWAN/RECOMB TSH REMNANT-RRA,30mCi FOLLOW UP WITH TG,USG,RAD IODINE.

 CENTRAL COMPARTMENT DISSECTION.

FUNCTIONAL NECK DISSECTION.

COMPLICATIONS
PER OPERATIVE:1)INJURY TO RLN,EBSL,TRACHEA,CAROTID,OESOPHA GUS. 2)HEMORRHAGE 3)THYROID STORM EARLY POST OP RESP OBSTRUCTION LATE POST OP 1)HYPOPARATHYROIDISM 2)HYPOTHYROIDISM 3)RECUR

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