Download Free Medical Approach to a Case of Thyroid Nodule PowerPoint Presentation

Approach to a Case of Thyroid Nodule PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : This medical presentation on cancer titled "Approach to a Case of Thyroid Nodule" discusses approach to a case of thyroid nodule. It talks about benign (Follicular Adenomas, Multinodular goiter, Hashimoto’s thyroiditis, Cysts) as well as malignant (Papillary Carcinoma, Follicular Carcinoma, Medullary Carcinoma, Anaplastic and poorly differentiated carcinoma, Primary lymphoma of the thyroid, and Metastatic carcinoma) nodule.

Tags : Cancer, Approach, Thyroid Nodule, benign, Follicular Adenomas, Multinodular goiter, Hashimoto’s thyroiditis, Cysts, malignant, Papillary Carcinoma, Follicular Carcinoma, Medullary Carcinoma, Anaplastic, poorly differentiated carcinoma, Primary lymphoma, Metastatic carcinoma, Clinical features, INVESTIGATIONS, Ultrasonography, Radionuclide Scanning, Cold Nodules, Hot Nodules, Thyroid scan, cytology

Published on : May 05, 2021 | Views : 2356 | Downloads : 7

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

APPROACH TO A CASE OF THYROID NODULE By Prof. Arvind Mishra M.D. Department of Medicine
Slide 2-

Causes of Thyroid Nodularity Benign Follicular Adenomas Multinodular goiter Hashimoto’s thyroiditis Cysts (colloid, simple, hemorrhagic)
Slide 3-

Malignant Papillary Carcinoma Follicular Carcinoma Medullary Carcinoma Anaplastic and poorly differentiated carcinoma Primary lymphoma of the thyroid Metastatic carcinoma
Slide 4-

Clinical features Most thyroid nodules are asymptomatic Nodules that produce thyroid hormones in excess -palpitation -anxiety -clammy skin -increased appetite -weight loss -heat intolerance Nodules can press adjacent structures in neck causing -hoarseness of voice(recurrent laryngeal N compression) -dysphagia -dyspnoea -pain in neck
Slide 5-

Nodules sometimes found in hashimoto’s thyroiditis, which may cause symptoms of an underactive thyroid gland -dry skin -face swelling -intolerance to cold -weight gain -decreased appetite -hair loss
Slide 6-

INVESTIGATIONS ULTRASONOGRAPHY FNAC THYROID SCAN
Slide 7-

Ultrasonography Most sensitive test to detect lesions in the thyroid Indicated in all patients who have a nodular thyroid, with a palpable solitary nodule or a multinodular goiter,be evaluated by US Not as screening test in general population 7
Slide 8-

USG findings Number Size Extracapsular growth Cystic lesions Cervical LN 8
Slide 9-

Findings suggestive of malignancy: –Presence of halo –Irregular border –Presence of cystic components –Presence of calcifications –Heterogeneous echo pattern –Extrathyroidal extension
Slide 10-

Radionuclide Scanning Used to identify whether a nodule is functioning or not. Functioning nodules are nearly always benign Approximately 90 percent of nodules are nonfunctioning 5 percent of nonfunctioning nodules are malignant However even with suppressed level of serum TSH patient can have both functioning and non functioning nodules.Thus, even suppressed level of serum TSH may obviate the need for biopsy.
Slide 11-

Usually either Technetium(Tc99) or Radioiodine(I123) used. Normal follicular cells will trap both but only radioiodine is added to tyrosine and stored in the colloid space Both benign and almost all malignant neoplastic tissue concentrate both radioisotopes less than normal thyroid tissue
Slide 12-

Cold Nodules Cyst Non-functioning Adenoma Malignancy
Slide 13-

ppt slide no 13 content not found
Slide 14-

Hot Nodules Functioning Adenoma Thyroiditis Multinodular goiter
Slide 15-

ppt slide no 15 content not found
Slide 16-

Limitations of Thyroid scan Two dimensional scanning technique Inability to measure the size of a nodule accurately Missed malignant thyroid nodules
Slide 17-

Other imaging tech CT and MRI not as routine. Can asses size, retrosternal extension, position and relation to the surrounding structure. 17
Slide 18-

18 Images of a large, asymmetric multinodular goiter. (A) Chest radiography shows marked tracheal deviation to the right (arrow). (B) Chest CT confirmed the presence of a large substernal goiter on the left to the level of tracheal bifurcation.
Slide 19-

USG guided FNAC Indicated if: Palpation-guided FNAC non-diagnostic Complex (solid/cystic) nodule Palpable small nodule (<1.5 cm) Impalpable nodule Abnormal cervical nodes Nodule with suspicious US features FNAC results are:70% Benign, 10% Malignant or suspicious of malignancy, and 20% Unsatisfactory 19
Slide 20-

ppt slide no 20 content not found
Slide 21-

Malignant (+ve) cytology Commonest is PTC(Papillary thyroid carcinoma): Characteristics cytological feature- psammoma bodies, orphan annie eye nuclei (cleaved nuclei) Others include: Medullary thyroid carcinoma(amyloid deposits,intracytoplasmic calcitonin), anaplastic carcinoma(cellular anaplasia) and high-grade metastatic cancers 21
Slide 22-

Suspicious cytology in FNAC Diagnosis cannot be made Inculdes: Follicular neoplasms, Atypical PTC, or Lymphoma 22
Slide 23-

FNAC Limitations The absence of malignant cells in an acellular or hypocellular specimen does not exclude malignancy Inability to reliably distinguish a benign follicular adenoma from a follicular malignant tumour
Slide 24-

TSH To detect early or subtle thyroid dysfunction. If TSH levels abnormal, free T3 & T4 should be measured to confirm the diagnosis TPOAb Thyroid peroxidase antibody Though characteristically observed in hypothyroidism, can also be seen in patients of hyperthyroidism and subacute thyroiditis
Slide 25-

Serum Tg Correlates with iodine intake and the size of the thyroid gland rather than with the nature or function of the nodule Seldom used in nodule diagnosis Extremely elevated levels of Tg may suggest thyroid metastasis. Serum Calcitonin Good marker for medullary carcinoma and correlates well with tumor burden
Slide 26-

ppt slide no 26 content not found
Slide 27-

MCQs
Slide 28-

1)Thyroid carcinoma associated with hypocalcemia is a)Follicular CA b)Medullary CA c)Anaplastic CA d)Papillary CA
Slide 29-

2)Lab investigation of patient shows low T3, low T4 and highTSH.Diagnosis a)Primary hypothyroidism b)Grave’s disease c)Hypothalamic failure d)Pituitary failure
Slide 30-

3)Excess iodine intake causes hypothyroidism.It is known as a)Wolff chaikoff effect b)Jod basedow effect c)Thyrotoxicosis factitia d)De quervain’s thyroiditis
Slide 31-

4)FNAC can not differentiate between follicular adenoma and carcinoma because it can not clearly shows a)Vascular invasion b)Extracapsular extension c)a+b d)Nuclear pleomorphism
Slide 32-

5)Subclinical hypothyroidism stands for biochemical evidence of hypothyroidism without any clinical features.Cut off TSH values are a)<5mU/L b)<8mU/L c)Normal d)<10mU/L