Académique Documents
Professionnel Documents
Culture Documents
• Treatment:
-Multinodular.-subt. Thyroidectomy.
-Toxic adenoma- Lobectomy.
MALIGNANT THYROID
TUMOURS.
• Malignant tumours: -F:M =3:1
–Three main types: Papllary(50%), Follicular (10-
25%),Anaplastic (25-40%). Others: Medullary &
lymphomas.
• Papillary Carcinoma:
-Rare after 40yrs.
–Slow growing solitary thyroid lump
–Enlarged palp. LNs
–Histology :Complex papillary folds lined by several
layers of cuboidal cells projecting into cystic spaces.
–Teatment :Total/Near total Thyroidectomy +
LN removal ; Hormone therapy (T3 20 qid); TSH
monitoring.
-Prognosis: Excellent -90% survival at 10yrs.
MALIGNANT THYROID
TUMOURS…
• Follicular Carcinoma:
-Usually solitary thyroid nodule in 30-50yrs.
–Common
haematogenous spread (20% pts have mets in lungs,
bone or liver). LN spread rare.
–Histology: Malignant cells arranged in
solid masses with rudimentary acini.
–Treatment: Ttl thyroidectomy with
preservation of the parathyroids and removal of all palp.
LNs. –Post op. radioisotope scan (+ve-
therapeutic doses of radio iodine.
–T3 for replacement &suppression
of TSH secretion. Monitoring for rec. (-thyroglobulin).
-Outcome:10yr survival=50%
MALIGNANT THYROID
TUMOURS …
• Anaplastic Carcinoma:
-Rapidly growing, highly
malignant.
-Commoner in elderly pts.
-Local invasion causes hoarseness (RLN),
compression symptoms (dyspnoea, stridor, dysphagia).
Cervical sympathetic involv. (Horner’s syndrome=
pupillary contraction, enophthalmos, narrow palp.
fissure, loss of sweating in head & neck).
-Pulm. Mets common.
–Treatment : Surg. To relieve symptoms;
DXT/Chemo of marginal value. –Prognosis-poor (70%
die 1yrof diagnosis