• A 36-year-old woman complains of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noted a change in her voice and she has difficulty swallowing solids. On physical exam, there is a palpable, nontender swelling in the front of her neck that moves with swallowing. There is no cervical lymphadenopathy. Lab studies show hypercalcemia. A radiograph of the cervical region shows irregular calcifications in mass, while an MRI of the abdomen shows confirms the presence of bilateral adrenal lesions. 
Follicular Adenoma
  • Introduction
    • most common benign thyroid neoplasm
  • Evaluation
    • radioactive iodine imaging 
      • cold nodule
    • histology
      • complete capsular confinement
  • Prognosis
    • small minority progress to follicular carcinoma
Papillary Adenocarcinoma
  • Introduction
    • 90% of all thyroid cancers 
    • female dominance
    • often multifocal
    • risk factors include radiation exposure to the head and neck
      • also associated with BRAF and RET oncogenes
  • Evaluation
    • histology
      • psammoma bodies (calcifications)
        • also seen in ovarian dysgerminomas and meningiomas
      • ground glass/empty nuclei
        • nuclear grooves
        • known as "Orphan Annie" eyes
      • cells organized into papillary "fingers"
  • Treatment
    • thyroidectomy + iodine radiotherapy
  • Prognosis
    • metastasis via lymphatics
    • very good prognosis
Follicular Carcinoma
  • Introduction
    • usually unifocal
      • cold nodule
  • Evaluation
    • histology
      • preservation of normal thyroid follicular architecture but proliferation
        • uniform follicles
      • may invade capsule or blood vessels
  • Prognosis
    • hematogenous metastasis
      • lungs most common
    • good prognosis
Medullary Carcinoma
  • Introduction
    • derived from calcitonin synthesizing C cells
      • presentation may be hypocalcemia
      • may also produce ACTH
    • 10% of the cases are familiar and associated with MEN IIa or IIb
      • associated with a ret mutation
    • 90% are sporadic.
    • risk factors for malignancy are previous irradiation of the neck, cold nodules, and family history.
  • Evaluation
    • serum calcitonin
      • tumor marker
    • histology
      • amyloid (consisting of calcitonin) 
    • pentagastrin infusion
      • hyperplasia present with high calcitonin level response following administration
B-Cell Malignant Lymphoma
  • Introduction
    • sequelae of Hashimoto's thyroiditis
Anaplastic Thyroid Cancer
  • Introduction
    • seen most commonly in the elderly
    • may be superimposed on multinodular goiter, follicular cancer
  • Prognosis
    • very poor prognosis

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