Thyroid tumors

Thyroid tumors can be:
 * 1) benign: adenoma;
 * 2) malignant;
 * 3) primary;
 * 4) epithelial: papillary ca, follicular ca, medullary ca, anaplastic ca;
 * 5) non-epithelial: malignant lymphoma, sarcomas;
 * 6) secondary: metastasis of breast, lung and kidney carcinoma.

Risk factors for the development of thyroid malignancy include:
 * ionizing radiation (previous irradiation of the neck);
 * genetic influences;
 * high level TSH;
 * untreated autoimmune thyroiditis
 * MEN2A syndrome
 * pheochromocytoma.

Epidemiology
 * have an increasing incidence, the most common endocrine tumors
 * they occur most often between the ages of 40 and 50, but are not uncommon in children either
 * more in women (2:1)

Differentiated thyroid carcinoma


> Differentiated carcinoma is the most common malignancy of the thyroid gland. We distinguish:
 * 1) Papillary carcinomas – they grow slowly x tend to local recurrences, they metastasize mainly to the cervical lymph nodes.
 * 2) Follicular carcinomas – metastasize hematogenously (bones, lungs).

Clinical picture

 * Solitary growing knot of solid consistency (sometimes already present in the goiter – faster growth + change of appearance at USG);
 * in advanced stage nodal metastases on the neck (less often distant metastases);
 * thyroid function is not altered (x functionally active metastases may be a source of hyperthyroidism).

Diagnostics

 * Clinical picture, USG, aspiration biopsy with cytological examination.

Therapy

 * Total thyroidectomy  (possibly in combination with selective modified block neck resection);
 * radioiodine therapy (iodine131I isotope);
 * external radiotherapy;
 * 'substitution-suppression therapy (synthetic analogues of thyroid hormones – levothyroxine, replaces missing hormones and inhibits TSH synthesis in the pituitary gland).

Thyroglobulin is used as an early marker of recurrence / metastasis.

Prognosis

 * Very good with early detection of the disease;
 * worse in elderly patients and in distant multiple metastases.

Anaplastic thyroid carcinoma


Anaplastic carcinoma of the thyroid gland is rare (1-5% of thyroid carcinomas). It usually affects people over 60-70 years of age. This type of tumor is characterized by rapid growth of the tumor node, invasion of the environment and mechanical syndrome (from oppression). It creates early distant metastases (nodes, lungs, liver, CNS).

Therapy

 * Radical surgery (total thyroidectomy),
 * palliation – cytostatics + external irradiation.
 * often treatment only symptomatic.

Prognosis

 * Unfavorable, median survival 5 months.

Medullary thyroid carcinoma
> Medullary thyroid carcinoma originates from parafollicular C-cells of the thyroid gland. In four clinical forms:
 * sporadic (70-80% of medullary carcinoma, the most aggressive)
 * familial (AD hereditary)
 *  MEN 2A and MEN 2B syndromes (together with pheochromocytoma, neurofibromas, parathyroid adenomas,...)

Clinical picture + diagnostics

 * Similar to |differentiated thyroid carcinoma,
 * secretes the calcitonin (marker),
 * is more aggressive than differentiated carcinoma, at the time of diagnosis there are metastases in more than 50% of cases,
 * in medullary thyroid carcinoma in connection with MEN 2A and MEN 2B syndromes vanillic acid is measured,
 * 50% of medullary ca produces CEA (carcinoembryonic antigen).

Therapy
Total thyroidectomy, external irradiation (C cells do not accumulate iodine), chemotherapy.

Prognosis
Despite the aggressiveness, the prognosis is favorable - 75% of patients survive 15 years.