高分化甲状腺癌的治疗课件.pptVIP

Management of Well Differentiated Thyroid Cancer Vivek Ramarathnam, M.D. SIU- Otolaryngology Grand Rounds 9/1/2005 Thyroid Nodules Between 4-7% of individuals in US have palpable thyroid nodules More common in women Increase in frequency with age Fewer than 10% of solitary nodules are malignant - Papillary (75%) - Follicular (15%) Thyroid Carcinoma 1.5% of all newly diagnosed cancers Number increasing over last 25 years; 4.8 to 8.0 cases per 100,000 Female predominance (11.7 female to 4.2 male cases/100,000 Death rate 0.5 cases per 100,000 Nodules and Carcinoma Rates Rates of carcinoma in a single nodule: 5-17% Rates of carcinoma in multinodular patients: 5-13% Risk Factors for Malignancy Prior irradiation Family history Male sex Nodules in individuals 15, 45 Symptoms of invasiveness: development of hoarseness, progressive dyshagia, or dyspnea Physical Examination Pulse rate, Blood Pressure Neck Lymphadenopathy Deviation of Trachea Palpation of Thyroid gland (Size, consistency, mobility, presence or absence of tenderness, multinodularity) Attention of thyroid mass to surrounding anatomy Preoperative Evaluation Individuals with symptoms potentially of invasive carcinoma- dysphonia, dysphagia, or stridor Flexible laryngoscopy MRI allows soft tissue evaluation (cervical esophageal invasion) CT, readily available, iodinated contrast used can delay the use of RAI postoperatively 4-6 weeks Selected patients, panendoscopy Thyroid Picture Thyroid Anatomy Arteries- Paired arteries, superior, inferior arteries Venous drainage- parallels arterial drainage, superior thyroid veins drain into internal jugular vein, inferior thyroid veins to brachiocephalics Lymphatics- intraglandular lymphatic network, paratracheal, upper, mid, and lower jugular nodes Thyroid Hormone Physiology Growth- hormones work in bone formation CNS- brain maturation Basal metabolic rate Cardiovascular and respiratory systems Metabolic effects Thyroid Histology Thyroid Hormone Regulation TSH sti