‫الر ْح َم ِن ه‬

‫الر ِح ِيم‬ ِ ‫ِب ْس ِم ه‬

‫َّللا ه‬

THYROID CANCER
Mutiara Wijayanti Haris Putri
30101407256
 Thyroid
Anatomy

SECTION DIVIDER
OPTION 2
FIRST UP 2
CONSULTANTS
THYROID PHYSIOLOGY
• Iodine Metabolism
 The thyroid is the storage site of >90% of the body’s iodine
content and accounts for one third of the plasma iodine loss.
• Product of Thyroid Hormone
 T3, T4, calcitonin.

FIRST UP 3
CONSULTANTS
THYROID HISTOLOGY
• Microscopically, the thyroid is divided into lobules
that contain 20 to 40 follicles.
• Each follicle is lined by cuboidal epithelial cells and
contains a central store of colloid secreted from the
epithelial cells under the influence of the pituitary
hormone TSH.
• The second group of thyroid secretory cells is the C
cells or parafollicular cells, which contain and secrete
the hormone calcitonin.

FIRST UP 4
CONSULTANTS
THYROID CANCER
In the United States, thyroid cancer accounts for
<1% of all malignancies (2% of women and 0.5%
of men) and is the most rapidly increasing cancer
in women. Thyroid cancer is responsible for six
deaths per million persons annually. Most patients
present with a palpable swelling in the neck.

FIRST UP 5
CONSULTANTS
 FIRST UP 6
CONSULTANTS
 FIRST UP 7
CONSULTANTS
SPECIFIC TUMOR TYPES
1. Papillary Thyroid Carcinoma (PTC)
 80% of all thyroid malignancies in iodine-sufficient areas and predominant thyroid
cancer in children and individuals exposed to external radiation, more often in
woman with 2:1 (female to male ratio), and mean age at 30-40 years.
• Symptoms :
 Euthyroid.
 Present with a slow-growing painless mass in the neck.
 Dysphagia.
 Dyspnea.
 Dysphonia usually are associated with locally advanced invasive disease.
 Lymph node metastases are common.
 Lateral aberrant thyroid almost always denotes a cervical lymph node that has
been invaded by metastatic cancer.
FIRST UP 8
CONSULTANTS
• Diagnosis is established by FNAB (Fine Needle Aspiration Biopsy) of the thyroid
mass or lymph node, ultrasound to evaluate the contralateral lobe and for lymph
node metastases in the central and lateral neck compartments.

FIRST UP 9
CONSULTANTS
• Treatments
‣ Current guidelines for the evidence based management of thyroid cancers
recommend a near total or total thyroidectomy for primary cancers >1 cm
unless there are contraindications to the surgery. But total thyroidectomy led to
a significantly improved recurrence and survival for tumors >1 cm.
‣ Patients with a nodule that is suspicious for papillary cancer should be treated
by thyroid lobectomy, isthmusectomy, and removal of any pyramidal lobe or
adjacent lymph nodes.
‣ RAI to effectively detect and treat residual thyroid tissue or metastatic disease.
• Prognosis : >95% 10-year survival rate.

FIRST UP 10
CONSULTANTS
2. Follicular Carcinoma
 10% of thyroid cancers and occur more commonly in iodine deficient areas, more
often in woman with 3:1 (female to male ratio), and mean age at 50 years.
• Symptoms :
 Solitary thyroid nodules.
 Long standing goiter.
 Painless.
 Hemorrhage into the nodule has occurred.
 Occasionally with a history of rapid size increase.
• The specific microRNAs miR-197 and miR-346 are upregulated in follicular
thyroid cancers and have the potential to be used as diagnostic markers.

FIRST UP 11
CONSULTANTS
• Treatments
‣ Total thyroidectomy is recommended by some surgeons in older patients
with follicular lesions >4 cm.
FIRST UP 12
CONSULTANTS
3. Hurthle Cell Carcinoma
 3% of all thyroid malignancies, are subtype of follicular thyroid cancer.
• Differ from follicular carcinomas in that they are more often multifocal and bilateral
(about 30%), are more likely to metastasize to local nodes (25%) and distant sites.
• Characterized by vascular or capsular invasion. Tumors contain sheets of
eosinophilic cells packed with mitochondria, which are derived from the oxyphilic
cells of the thyroid gland.
• Diagnosis is established by ultrasonography to evaluate lateral neck nodes.
• Treatments
‣ Lobectomy and isthmusectomy being sufficient surgical treatment for unilateral
Hurthle cell adenomas.
‣ Total thyroidectomy when found to be invasive on definitive paraffinsection
histology.
• Prognosis : a higher mortality rate (about 20% at 10 years).

FIRST UP 13
CONSULTANTS
4. Medullary Thyroid Carcinoma (MTC)
 5% malignancies and arises from the parafollicular or C cells of thyroid, more
often in woman with 1.5:1 (female to male ratio), and present at a younger age.
• Symptoms :
 A neck mass that may be associated with palpable cervical lymphadenopathy
(15% - 20%).
 Pain or aching.
 Dysphagia.
 Dyspnea.
 Dysphonia.
 Lymph node metastases are common.
 Extensive metastatic disease frequently develop diarrhea.
• Microscopically, tumors are composed of sheets of infiltrating neoplastic cells
separated by collagen and amyloid.

FIRST UP 14
CONSULTANTS
• Diagnosis is established by immunohistochemistry for calcitonin is more commonly
used as a diagnostic tumor marker, CEA levels, and FNAB cytology of the thyroid mass.
Ultrasound to evaluate the central and lateral neck compartments and the superior
mediastinum. Chest CT and a triple-phase liver CT or contrast-enhanced MRI is
recommended to assess for metastatic disease.
• Treatments
‣ Total thyroidectomy is the treatment of choice for patients with MTC because of the
high incidence of multicentricity.
• Prognosis : 80% 10-year survival rate, 45% in patients with lymph node involvement.

FIRST UP 15
CONSULTANTS
5. Anaplastic Carcinoma
 1% of all thyroid malignancies.
• Symptoms :
 Long-standing neck mass.
 Rapidly enlarges and may be painful.
 Dysphonia.
 Dyspnea.
 Dysphagia.
• Diagnosis is established by FNAB revealing characteristic giant and
multinucleated cells. Differential diagnoses on FNA can include lymphomas,
medullary carcinomas, direct extension from a laryngeal carcinoma, or other
metastatic carcinomas or melanoma. Core or incisional biopsy occasionally is
needed to confirm the diagnosis, especially when there is necrotic material on the
FNA.

FIRST UP 16
CONSULTANTS
• Microscopically, sheets of cells with marked heterogeneity are seen. The three main
histologic growth patterns are spindle cell, squamoid, and pleomorphic giant cell.
• Diagnosis by Imaging (ultrasound, CT, MRI, or PET-CT) should be obtained to assess
resectability.
• Treatments
‣ All patient should have preoperative laryngoscopy to assess the status of the vocal
cords.
‣ A total or near-total thyroidectomy with therapeutic lymph node dissection is
recommended for patients with an intrathyroidal mass
• Prognosis : patients surviving 6 months beyond diagnosis.

FIRST UP 17
CONSULTANTS
 ‫سالَ ُم َو َر ْح َمةُ ِ‬
‫هللا َوبَ َر َكاتُهُ‬ ‫علَ ْي ُك ْم ال ه‬
‫َو َ‬

‫‪FIRST UP‬‬ ‫‪18‬‬

‫‪CONSULTANTS‬‬