Introduction

There are five main types of thyroid carcinoma, and their properties are given below:
Cell type
Frequency
Behaviour
Spread
Prognosis
Papillary
70%
Occurs in young people
Local – sometimes bone / lung secondaries
Good, especially in young patients
Follicular
20%
More common in females
Lung / Bone
Good if resectable
Anaplastic
<5%
Aggressive, often constricts the airway
Locally invasive
Very Poor
2%
Variable
Locally invasive
Poorbut sometimes responds to radiotherapy
Medullary cell
5%
Often familial
Local and mets
Poor, but often very slow course

Thyroid tumours are not very common – they are responsible for about 400 deaths in the UK per year.
90% of cases present with thyroid nodules.

Papillary and follicular carcinomas

  • The primary treatment is near-total thyroidectomy. Where there is local spread, more dissection of the neck may be needed.
  • After this initial surgery, if there is still the possibility of some diseased tissue still present, then radioiodine may be given. This is also useful as it can be used to locate metastasis.
  • Local lymph nodes, as well as the lungs and bones are the most common sites of spread.
  • After treatment, even if there is functioning thyroid tissue left, patients may be given thyroid hormone to suppress TSH secretion. This helps to monitor the presence of any further carcinoma as high levels of T3/T4 present in the blood at this stage hint at further disease presence.
  • The prognosis is extremely good – particularly if the patient is under 40, and the tumour confined to the thyroid –Anaplastic / lymphoma
  • In contrast to above, these have an extremely poor prognosis. They do not respond to radioiodine, and external radiotherapy may produce a very brief respite. –Medually carcinoma
  • This is often associated with multiple endocrine neoplasia.
  • It is usually treated by total thyroidectomy
  • Progression is often slow, but the tumour responds very poorly to treatment and often spreads.
  • The patient’s family should be screened for this and other neoplastic conditions

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