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.
History
Detailed history should include:
Age , Sex, Hoarseness, Obstructive symptoms, Progression, Pain, dysphagia, H/o childhood irradiation, Family history, Symptoms of toxicity.
Physical examination
- General
- 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
- Tracheal shift
- Mediastinal external
- Pulmonary metastasis
- Other co-morbid
Ultrasonography
- Difference cystic/nodular
- Solitary or multinodule (cystic up to 1 mm/solid up to 3mm)
- Tumour size
- Calcification(MTC)
- Extracapsular extension
- Vascular invasion
- Neck nodes(level i-vii)
- Assist FNAC
- Involvement of contralateral lobe
Radiology
- Extent and relationship
- Indication: Large retrosternal extension
- Multiple LN deposits
- Pulmonary metastasis
- Abdominal CT lymphoma staging
- MRI may detect vessel involvement
Laboratory investigation
- T3 and T4
- Serum calcium
- Thyroid antibodies
- Thyroglobulin
- Calcitonin
Cytology: FNAC is cheap, safe and reliable
- FNAC do not distinguish between benign and malignant follicular neoplasm
- FNAC can miss multifocal cancer.
Scintigraphy:
- Gold standard
- 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.
