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T/F

Thyroid cancer is the most common malignancy of any type of cancer.
False!

But it is the most common of the endocrine system.
Thyroid cancer is classified by what type of features?
Histologic features
What type of thyroid tumors are often curable, with universally good prognosis?
Differentiated tumors
What type of tumors respond poorly, with more bleak outlook?
Undifferentiated tumors
What has always been the primary risk factor in thyroid cancer?
Radiation, hence the shielding that is implemented in x-ray
T/F

Radiation exposure in childhood carries an increased LIFETIME risk.
True!
What are the risk factors for thyroid cancer?
Radiation, TSH and growth factors, oncogenes and tumor suppression genes

Geography, age, beverages consumed, standard risk factors
In what states is thyroid cancer anywhere from 2 to 10 times more common?
Nevada, Utah, Idaho, and Wyoming
How long after rads exposure does thyroid malignancy occur?
When is the peak?
10 to 40 years after

Peak occurrence is at 20-25 years
a) Following the Chernobyl explosion, the risk for developing thyroid carcinoma was highest among children who were under ___ yrs old at the time of exposure.

b) Emergence of more aggressive thyroid carcinoma began occurring within ___ years after exposure.

c) To date (2 years ago), there were how many reported cases of thyroid carcinoma, with more to come?
a) 5
b) 6
c) 11,000
What are the different types of benign thyroid tumors (follicular adenomas)?
Macrofollicular (colloid)
Normofollicular (simple)
Microfollicular (fetal)
Trabecular (embryonal)
Hurtle cell variant (oncocytic)
Which nerve runs through the thyroid gland?
Recurrent laryngeal nerve
What are the different types of malignant thyroid neoplasms?
Papillary carcinomas: 80%
Follicular carcinomas: 5-10%
Undifferentiated anaplastic carcinoma: 1-5%
Medullary carcinoma: 10%
Other malignances: 1-2%
What is the most common type of malignant thyroid neoplasm?
Papillary carcinomas
What is the average yearly exposure to radiation?
0.1 rads
What is the average chest x-ray exposure to radiation?
0.007 rads
What is the average radiation exposure on a cross country airline flight?
0.005 rads
What is the average radiation exposure in a thyroid scan?
0.4-2.0 rads (depending on dosage)
What is the average radiation exposure in a thyroid ablation?
100 rads plus??
What factors does the online radiation calculator use?
Age, milk consumption (cow vs. goat), water consumption (equalizes), and county
How many detonations (atmospheric) were done at the Nevada test site?
90
Which time period did they do above ground testing?
Below ground testing?
1951 to 1962, above ground testing
1962 to 1992, 825 below ground tests
Exposure to I 131 lasts for up to how many months after each above ground detonation?

What is the average rads per American?
2 months

Average of 2 rads to every American, with maximum of 300 rads
What kind of nuclear testing do they do today?
Non fission underground tests
What was Operation Crossroads?
Bikini Island Atoll
Detonated 90 ft underwater
Tests effect on ships and equipment
90 vessels tested
42,000 military
Aborted due to rads
What was Operation Plowshare?
Displaced 12m tons
320 ft deep
1280 ft wide
Used for construction
Panama canal (didn't actually end up using it for this)
Alaskan harbor
What are some thyroid carcinoma presenting signs and symptoms?
Palpable, firm, nontender nodule
Dysphagia
Hoarseness (b/c of recurrent laryngeal)
Lymphadenopathy
Endocrine side effects (flushing, Cushings,
thyrotoxicosis)
What are possible endocrine side effects of thyroid carcinoma?
Flushing, Cushings, thyrotoxicosis
What are the components/steps of a thyroid work-up?
HISTORY!!! Birth date and place on every patient!! (where’ya from?)
Examine thyroids!!
Thyroid ultrasound
Thyroid scan, if indicated
Thyroid biopsy, if indicated
What are some differences between near-total thyroidectomy and lobectomy?
Lobectomy: lower incidence of hypoparathyroidism, rec. laryn. damage

Near-total: accurate dx and staging, common to have disease in contralateral lobe, able to follow thyroglobulin as TM, no repeat surgery with recurrence, can repeat I131 tx.
What can you suppress TSH with?

At what level should TSH be at?
Thyroid hormone

TSH should be nondetectable, or as close as is tolerable, without hyperthyroid symptoms
Why is TSH suppression important?
Because TSH is causing cancer, if you have a tumor you don't want TSH around. You want to shut pituitary off for TSH. You don't want any stimulation of thyroid tissue after ablation.
Radioiodine (I 131 ablation) treatment requires what hormone to uptake it?
Why?
Requires TSH to uptake

Cancer cells uptake iodine, but not as readily as normal cells. You can't suppress TSH and then do radioiodine. First, they need to be off thyroid (TSH above 60). Must be hypothryoid before ablating.
What is now available that dismisses the need for a difficult thyroid withdrawal period in radioiodine (I 131 ablation) treatment?
Recombinant human TSH (rhTSH)
What exams/tests should be done for follow-up after treatment of thryoid cancer?
Yearly whole body thyroid scans
Thyroglobulin assays in conjunction with scans
Follow TSH levels
External beam radiation for recurrence and metastatic disease
What is cheap and can be used to prevent thryoid cancer?
Potassium Iodide

Controversy on prophylaxis
Blocks uptake of radioactive iodine in the thyroid
Only protects thyroid
What act gives $50,000 to affected individuals, displaying one or more “approved” tumors, who lived in an “approved” County?
Radiation Exposure Compensation Act