How will you manage a case of papillary carcinoma of 27 year old male presented with solitary thyroid nodule of 2cm in his left lower pole along with multiple ipsilateral mobile lymphonode in level III, IV and V but without distant metastasis?
The given scenario suggest that patient belongs to the below mentioned group:
High risk patient with High risk tumour & N1b nodal status and M0
T1 N1 Mo with high risk (stage IV A)
Total thyroidectomy c parathyroid preservation and Selective neck dissection IIb-Vb +Post operative radiotherapy and RIA should be the choice of treatment.
Detailed history should include:
Age , Sex, Hoarseness, Obstructive symptoms, Progression, Pain, dysphagia, H/o childhood irradiation, Family history, Symptoms of toxicity.
L/E THYROID IS DONE ONE SIDE AT A TIME : Look for overlying skin consistency + Examination of neck nodes, Pharynx, Larynx and trachea
Indirect Laryngoscopy: Fibre-optic endoscopy of vocal cord to rule out palsy/ invasion
Chest radio graph
Solitary or multinodule (cystic up to 1 mm/solid up to 3mm)
Neck nodes(level i-vii)
Involvement of contralateral lobe
Extent and relationship
Indication: Large retrosternal extension
Multiple LN deposits
Abdominal CT lymphoma staging
MRI may detect vessel involvement
T3 and T4
Cytology: FNAC is cheap, safe and reliable
FNAC do not distinguish between benign and malignant follicular neoplasm
FNAC can miss multifocal cancer.
visualizes nodules greater than 5 mm
uses- 123I – Thyroid pathology
123I-MIBG -(monoiodobenzyl guanidine) MTC, suspect of MEN
Ga citrate- lymphoma (use in long standing Hashimoto thyroiditis)
99m Tchnetium now used for various reasons like half life of 6 hrs, cheap readily available, low radiation dose. It is trapped but not organified.