MCQ - Thyroid malignancy I
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What is “Lateral aberrant thyroid”?
Almost always denotes a cervical lymph node that has been invaded by metastatic cancerQ
The MC sites of metastasis in papillary carcinoma?
LungsQ >bone >liver >brain.
Types of Papillary Carcinoma Associated with Poor Prognosis?
- 1. Tall cellQ
- 2. InsularQ
- 3. ColumnarQ
- 4. Diffuse sclerosingQ
- 5. Clear cellQ
- 6. TrabecularQ
- 7. Poorly differentiated type
Psammoma Bodies (PSM) are found in?
- 1. Papillary carcinoma thyroidQ
- 2. Papillary carcinoma (RCC) Q
- 3. Serous cystadenomaQ
- 4. MeningiomaQ
Half life of T3 and T4?
T3 has a shorter half-life than T4 (1 day vs. 1 week)
Dose of RAI ablation therapy?
- Screening dose of 1 to 3 mCi of 123I and measuring uptake 24 hours later. After a total thyroidectomy, this value should be <1%.
- If there is significant uptake, then a therapeutic dose of 131I, 30 to 100 mCiQ should be administered to low-risk patients and 100 to 200 mCi in high-risk patientsQ.
- Low-iodine diet also is recommended during this 2-week periodQ
- Patients with previously positive scans and patients with serum Tg levels >2 ng/mLQ usually need another 131I treatment after 6 to 12 months until one or two negative scans are obtained.
Significance of External Beam Radiotherapy?
EBRT is occasionally required to control unresectable, locally invasive or recurrent disease and to treat metastases in support bonesQ to decrease the risk of fractures, control pain due to bone metastasis
Thyroglobulin level after total thyroidectomy?
<2 ng/mLQ when the patient is taking T4 , and
<5 ng/mL when the patient is hypothyroid.
Cervical ultrasound after total thyroidectomy?
To evaluate the thyroid bed and central and lateral cervical nodal compartments should be performed at 6 and 12 months post-thyroidectomy and then annually Qfor at least 3 to 5 years, depending on the patients’ risk for recurrent disease and Tg status.
Differentiating features between papillary and follicular carcinoma?
- In papillary – lymph node metastasis, and bilateral
- In follicular – Hematogenous spread, more in males, higher overall mortality
Location of Aberrant thyroid tissues?
Found along the course of the thyroglossal tract: − LingualQ − CervicalQ – ThoracicQ
Thickness penetrated by radioactive iodine?
Mechanism of Action of I131?
Emits beta particlesQ and X-rays. Beta rays are utilized for their destructive effects on thyroidQ cells
Mode of spread of thyroid cancers?
- Papillary carcinoma - LymphaticQ spread
- Follicular carcinoma - HematogenousQ spread
- Medullary carcinoma - Both lymphatic and hematogenousQ spread
- Anaplastic carcinoma - Direct invasionQ
MC site of Metastasis of thyroid cancers?
- Papillary carcinoma - LungsQ
- Follicular carcinoma - BonesQ
- Medullary carcinoma- LiverQ
- Anaplastic carcinoma – LungsQ
Causes of Pulsating Secondaries?
- 1. Follicular carcinoma thyroidQ
- 2. RCCQ
Bone Metastasis in Carcinoma Thyroid?
- Follicular carcinoma Osteolytic metastasis (Pulsating secondaries in flat bones) Q
- Medullary carcinoma Osteoblastic metastasisQ
Genes implicated in Follicular carcinoma of thyroid?
p53Q, PTENQ, RasQ , PAX8/PPAR1
Histology of Follicular carcinoma?
- Follicles are present, but the lumen may be devoid of colloidQ.
- Malignancy is defined by the presence of capsular and vascular invasionQ.
Difference between Hürthle cell Tumors from Follicular Carcinomas?
- Hurthle cells tumors are the subtypes of follicular carcinoma but have the following differences
- 1. More often multifocal and bilateral (about 30%)Q
- 2. Usually do not take up RAI (about 5%)Q
- 3. More likely to metastasize to local nodes (25%) and distant sitesQ
- 4. Associated with a higher mortality rateQ (about 20% at 10 years)
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