THYROID NEOPLASMS

1. Thyroid Neoplasms
Benign
1. Adenoma
•Follicular – colloid, embryonal,foetal
•Hurthle cell
2. Teratoma

2. Thyroid Neoplasms
Malignant Tumours:
1. Well differentiated


Papillary
Follicular
Hurthle cell
2. Undifferentiated
Anaplastic
3. Medullary carcinoma

3. Thyroid neoplasms
Lymphomas
Hodgkin`s lymphoma
NonHodgkin`s lymphoma
Others
Squamous or Mucinous
carcinoma
Secondaries

4. Aetiology of Thyroid
carcinoma
Molecular Biology
RET – oncogene Papillary ca.
& medullary carcinoma
ras mutations in follicular ca.
P53 mutations in anaplastic ca.

5. Aetiology of thyroid ca

Radiation
Iodine excess/ deficiency

6. Pap Ca 60%
Foll Ca 17%
Anaplastic 13%
Medullary 6%
Lymphoma 4%

7. Incidence 3.7/100000
Females more affected
3:1
Mortality 2-3%

8. Papillary carcinoma
 Most common – 60 to 70%.
 Least aggressive cancer.
 Prolonged course.
 3
rd
and 4
th
decades of life.
 More common in women.
 Predominant thyroid cancer
in children.

9. Pathology
Grey white poorly defined nodule
varying in size from a few mm. To
several cms.
In large lesions, haemorrhage, necrosis
and cyst formation with visible papillae
may be seen.

10. Pathology - Microscopy
Typical papillary structures
Optically clear nuclei called Orphan
Annie nuclei
Round laminated calcified bodies –
psammoma bodies.
Nuclear grooves,lobulations and atypia

11. pathology
Multiple foci in same lobe
Sometimes opposite lobe
Intrathyroidal lymphatic spread/
Multicentric growth

12. Pathology
They grow slowly and tend to
metastasize to lymph nodes
Better prognosis than other forms of
thyroid cancer
Tendency to more malignant growth
with advancing age
Local spread to trachea,recurrent
laryngeal nerve and oesophagus

13. Occult carcinoma
Papillary CA less than 1.5 cm
Palpable LN
Jugular chain
Primary may be only few mms size

14. Clinical Features
Solitary Nodule (STN)
Dysphagia,dyspnoea,hoarseness
indicate locally invasive disease
Lymph node enlargement
Occasionally lymph node enlargement
alone

15. Investigations
Thyroid function tests
Ultrasound scan
Isotope thyroid scan
 Fine needle aspiration cytology

16. Treatment
Near total/total thyroidectomy
Lobectomy/Hemithyroidectomy
Modified neck dissection
TSH suppression

17. Total thyroidectomy
hemithyroidectomy

18. Thyroid suppression
0.1-0.2 mg daily
Suppress endogenous TSH
Not very much useful in follicular Ca

19. Thyroglobulin
Tumour marker
Obviate the need of serial isotope
scanning
Only adjunct to clinical examination

20. Follicular carcinoma
Occurs in the fifth decade
More common in females
15% of thyroid malignancies
Occurs more frequently in iodine
deficiency areas
More aggressive and dangerous
Blood stream spread

21. Pathology
Tumour is well encapsulated
.
Haematologic spread

22. Microscopy
Follices are crowded with cells
with hardly any colloid.
Capsular and vascular invasion are
prominent features.
Tumour with large cells with
abundant eosinophilic cytoplasm
are called Hurthle cell carcinoma

23. Clinical features
Solitary nodule or multiple painless
nodules
May arise in a long standing goiter
Lymph node involvement rare
Haematogenous spread to bones lungs
or liver
Bony metastasis may be pulsatile

24. Investigations
FNAC not helpful
Radiology - X –ray chest , neck, bones,
CT scan
Raio isotope scan

25. Treatment
Total thyroidectomy/Near total
thyroidectomy
Radioiodine
External beam radiation
Chemotherapy
TSH suppression

26. Prognosis of DTC
Age
Histological variant
Extra thyroidal spread
size

27. Low risk
Men<40, women<50
Older patients
- intrathyroid papillary Ca
-foll with minor caps. Invasion
-<5cm
-no distant mets

28. High risk
Distant mets
Older patients
- extra thyroidal Pap
- major caps.invasion
- >5 cm

29. 2% mortality in 25 yr survival in low risk
group
46% in high risk group

30. Medullary carcinoma(MTC)
Arises from the C – cells
,derived from the neural crest –
APUD system
Sporadic or familial form

31. Familial MTC
Familial with MTC only
with MEN IIA –
MTC
hyperparathyroidism &
phaeochromocytoma

32. MTC secretes calcitonin
CEA,
histamine,and
serotonin

33. Pathology
Sporadic form – usually unilateral,
familial form – multinodular
Sheets of infiltrating malignant cells
with areas amyloid
Special staining can be performed for
calcitonin in the cells
Lymphatic & haematogenous spread

34. Clinical features
Age – sporadic form (80%) 40 – 60 yrs.
Familial (20%) – younger age group
Single nodule (sporadic) , multinodular
(familial)
Lymph node enlargement +(- )
Dysphagia ,dyspnoea hoarseness
MEN IIA - symptoms of
hyperthyroidism or
phaeochromocytoma

35. Investigations
FNAC OF Thyroid mass
Urinary metabolites –
VMA,metanephrine,catecholamine
Serum Calcium
USG Abdomen
Serum calcitonin

36. Treatment
Total thyroidectomy with central neck
dissection
External – beam radiotherapy in
unresctable disease

37. Anaplastic thyroid
carcinoma
Rapidly growing tumours with invasion
of surrounding structures
Lymph node involvement is frequent &
early
Foci of both undifferentiated and
differentiated cells are seen in follicular
or papillary pattern

38. Clinical features
Presents with rapidly progressive lump
of short duration
May be painful or ulcerated
Compressive symptoms+
Mass hard and fixed to the surrounding
structures
Stridor+
Metastasis lymph nodes, liver ,lungs.
bones

39. Treatment
FNAC – diagnostic
Treatment – disappointing
Debulking , tracheostomy radiotherapy

40. Secondaries
Breast
Colon
Kidney
Melanoma

41. hypothyroidism
Commonest endocrine problem
5% of female population affected

42. Types
Primary
Secondary
tertiary

43. Primary
Auto immune
Surgery
Radioactive iodine
Ext.beam RT to neck
drugs

44. Hashimoto’s thyroiditis
Auto immune
Familial
Females 9:1
40-50 yrs

45. features
Compensated hypothyroidism
Hyperthyroidism
hypothyroidism

46. TSH
ANTIBODIES
antimicrosomal
antiTG

47. Treatment
Normalise the TSH

48. Complications
Other autoimmune disorders
lymphoma