Thyroid Papillary and Follicular Ca - SPorter

Thyroid Papillary and Follicular Ca - SPorter - Thyroid...

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Thyroid cancer Papillary and follicular thyroid carcinoma: Controversies in follow-up Steven B. Porter, MD PGY-1, Department of Surgery Team IV Rounds June 20, 2008
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2 Thyroid cancer Outline Case Presentation “Differentiated Thyroid Cancer” Papillary Thyroid Carcinoma Follicular Thyroid Carcinoma Cohort Data Analysis of Data Summary
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3 Thyroid cancer Negative Outline No discussion of medullary thyroid ca No discussion of MEN2a, MEN2b No discussion of surgical technique (as I haven’t seen surgery on a thyroid since 2005)
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4 Thyroid cancer Case presentation HPI: M is a 30 yo M referred to endocrine surgery for a palpable thyroid nodule on physical exam by PMD. No dysphonia, dysphagia, odynophagia, change in voice. No smoking history. Recent cough for a few weeks. No fevers, chills, weight loss. No hx of radiation to neck
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5 Thyroid cancer Case Presentation cont’d PMH: major depressive disorder, sleep apnea Meds: desipramine, buproprion PSH: left shoulder surgery 1996, pilonidal cyst excision 2000 All: NKDA FHx: M: Hashimoto’s, F: benign goiter MAunt: hypothyroidism SHx: no tobacco, social etoh, no drugs
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6 Thyroid cancer Case Presentation cont’d PE VS: unable to obtain (afebrile, normotensive) Gen: NAD, healthy appearing HEENT: palpable ~3 cm nodule in thyroid R lower lobe CV: RRR, no murmurs Pulm: CTA b/l, no wheezes Abd: SNTND Extr: 2+ DP pulses b/l
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7 Thyroid cancer Case Presentation cont’d: US and FNA US: Hypoechoic nodule in R lower lobe with punctate calcifications and some cystic degeneration measuring 2.9 x 3.0 x 3.4 cm sagittal . At the extreme R right lower pole, an adjacent hypoechoic nodule measured 1.2 x 1.6 x 1.4 cm sagittal with irregular margins. In the mid-R lobe, a cystic nodule measured 0.9 x 1.0 x 0.9 sagittal. A mid-L complex nodule with isoechoic solid elements measured 0.9 x 1.4 cm sagittal. A lower L hypoechoic nodule measured 0.7 cm FNA : Positive for malignant cells. Papillary thyroid carcinoma . Foamy cells c/w cyst contents and/or cystic degeneration. Scant colloid. Rare nuclear grooves present. Rare intranuclear inclusions present.
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8 Thyroid cancer Case Presentation cont’d Hospital Course DAS for total thyroidectomy Palpable pretracheal and paratracheal lymph nodes in OR central LN dissection, PACU iCa: 1.11 POD#1: tolerating diet, afebrile, FROM of neck, JP d/c’d, iCa: 0.96, 1.0, 1.03 POD#2: iCa: 1.04, d/c’d to home on vitamin D and calcium carbonate
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9 Thyroid cancer Case Presentation cont’d Pathology L lateral paratracheal LN: 1/1 met papillary ca Lateral paratracheal tissue: 1/3 met papillary ca Thyroid gland: well differentiated papillary thyroid ca extensively involving b/l thyroid lobes and isthmus (largest R lobe tumor measuring 4.6 cm). Tumor extending to perithyroid soft tissue and is <1 mm from
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Thyroid Papillary and Follicular Ca - SPorter - Thyroid...

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