Malignancies of the thyroid gland
It can be anaplastic, follicular, medullary or anaplastic types on microscopy. Risk factors include family history, female sex and previous neck irradiation. Non Hodgkin’s lymphoma is seen in Hashimoto’s thyroiditis. Anaplastic carcinoma has a bad prognosis. It presents with a neck mass, thyroid nodule, lymphadenopathy, dysphagia, dyspnea, fatigue and weight loss. Evaluation is with ultrasound which shows microcalcifications, increased vascularity and hypoechoic mass. Ultrasound is followed by biopsy. Iodine scan may show a cold or hot nodule. Serum thyroglobulin is a tumor marker for thyroid cancers. Treatment is by thyroidectomy with RAI or radioiodine ablation and TSH suppression. Lobectomy is done for small nodules without local or distant spread. RAI helps to control distant metastases. TSH suppression is done by administering thyroid hormone. Total thyroidectomy is done for lesions greater than 1 cm. Lymph node dissection is done in the presence of metastatic lymphadenopathy. Medullary carcinoma is always treated by thyroidectomy, calcitonin can be used as a tumor marker.
Types of thyroid cancers
| Type | Features |
| Papillary | RET and BRAF mutations; multiple foci; shows papillary projections, Psammoma bodies, Orphan Annie nuclei |
| Follicular | Abnormal follicles, capsular and vascular invasion |
| Medullary | Origin from parafollicular C cells, amyloid deposits, calcitonin positive; associated with MEN 2A and B; RET mutations |
| Anaplastic | P53 and BRAF mutations; poorly differentiated, giant cells |
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