Children exposed to the Chernobyl disaster in 1986 subsequently demonstrated an increased incidence of which thyroid cancer?
Papillary thyroid cancer accounts for 80% of all thyroid malignancies and is the predominant thyroid cancer in children and individuals exposed to external radiation.
The recommended treatment for an otherwise healthy 50-year-old man with a 2-cm PTC in the left lobe diagnosed by FNAB is:
Total thyroidectomy or total lobectomy on the affected side with subtotal lobectomy on the nonaffected side is the recommended treatment of choice for unifocal PTC greater than 1 em in diameter. Definitive operation can be performed without frozen section when the diagnosis is unequivocal on FNAB.
An adolescent patient with a thyroid mass undergoes FNAB which returns as MCT. What other diseases should be screened for before treatment is undertaken?
MCT can be spontaneous (in 75%) or familial (in 25%) in MEN2. MEN2A is associated with pheochromocytoma and hyperparathyroidism, whereas MEN2B is associated with pheochromocytoma, Marfanoid habitus, and mucocutaneous ganglioneuromas.
An asymptomatic child with a normal physical examination is found to harbor a mutation in codon 918 of the RET tyrosine kinase receptor, compatible with MEN2B. Ultrasound of the neck is unremarkable and serum calcitonin levels are normal. What course is indicated?
Children with mutations at codon 634 of the RET tyrosine kinase receptor gene (MEN2A) are advised to undergo thyroidectomy before age 5, whereas children with mutations at codon 918 (MEN2B) should undergo thyroidectomy before age 1. If ultrasound of the neck is normal and calcitonin levels are normal, a formal neck dissection can be avoided.
Postoperative complications within 24 hours of thyroid surgery include:
Inadvertent injury (ischemia) or removal of the parathyroid glands can cause acute neuromuscular excitability due to hypocalcemia. An expanding hematoma in the neck may not cause bleeding from the wound, but can compress the membranous portion of the trachea and cause dyspnea. Nerve injuries can cause vocal cord paralysis or impaired speech.
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