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The app is regularly updated to align with the latest NEET PG exam patterns and includes new questions as per evolving trends in medical entrance exams.

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CARCINOMA OF THYROID MANAGEMENT

The treatment of choice for patients diagnosed with thyroid cancer is surgery, when possible. Usually, surgery is followed by treatment with radioiodine and thyroxine therapy. Generally, radiation therapy and chemotherapy do not have a prominent role in the treatment of thyroid cancer.

Radioactive iodine ablation

Postoperative whole-body scintigraphy scan may identify previously unrecognized disease and influence staging. If residual disease is found, adjuvant therapy with radioactive iodine (RAI) may be considered. Ablation of residual normal thyroid tissue facilitates early detection of recurrence based on serum thyroglobulin measurement and/or RAI whole-body scan.

RAI ablation is indicated for patients with any of the following:

Large (>4 cm) tumors
Known distant metastasis
Gross extrathyroid extension

RAI ablation may be considered for tumors with the following characteristics:

Moderate-size (1-4 cm) and node positive
Grossly multifocal
Aggressive, based on histology
High risk, based on patient factors (age >45 y, history of head and neck radiation, family history of thyroid cancer)

RAI ablation is not recommended for the following:

Small
Multifocal tumors when all foci are < 1 cm
Early data suggest that RAI is equally effective when used with thyroid hormone withdrawal or with recombinant human thyroid-stimulating hormone (rh-TSH) stimulation.
Thyroid-stimulating hormone (TSH) suppression therapy (levothyroxine)
TSH suppression to < 0.1 mU/L is indicated in intermediate and high-risk disease. TSH maintenance at or slightly below the lower-normal limit (0.3-2 mU/L) may be considered for low-risk disease
Therapy for unresectable gross residual or recurrent disease or metastases

Therapeutic options in patients with unresectable gross residual or recurrent disease or metastases are as follows:

Unresectable gross residual/recurrent disease/metastases may be treated with external beam radiation therapy (EBRT)
Consider systemic treatment in the context of a clinical trial for persistent metastatic disease despite radioiodine, TSH suppression, and radiotherapy
Consider tyrosine kinase inhibitors (TKIs) such as sorafenib 400 mg PO BIDor sunitinib 50 mg PO daily for 4wk of a 6-wk cyclefor patients who cannot participate in a clinical trial, as well as for those who are not likely to tolerate systemic therapy; since these drugs are usually tumorostatic rather than tumoricidal, they are considered second-line therapy compared with systemic treatments in clinical trials
Pazopanib 800 mg PO daily may be considered for progressive or symptomatic metastatic differentiated (Hürthle cell, papillary, and follicular) thyroid carcinoma
Randomized phase III clinical trials supporting a TKI benefit in thyroid cancer are currently unavailable; thus, there are no specific regimens
Doxorubicin 60 mg/m² as monotherapy or in combination with cisplatin 40 mg/m² may be considered for patients who cannot tolerate TKIs or in whom TKIs have failed; however, the efficacy of these, and other cytotoxic drugs, is very limited

Exam Important

Ligation of inferior thyroid artery during thyroidectomy is done maximally away from the gland
Thyroxine can be given in Papillary thyroid carcinoma
After thyroidectomy for medullary carcinoma of thyroid recurrence of tumour can be determined by Carcinoembryonic antigen
Marker for follow-up of patient undergone total thyroidectomy for papillary carcinoma of thyroid is Thyroglobulin
In treatment of papillary carcinoma thyroid, radioiodine destroys the neoplastic cells predominantly by ri rays
A female presented with severe secretory diarrhea and the thyroid carcinoma can be treated by Surgery only.
Complications of total thyroidectomy is Hypercalcaemia
The drug used in the management of medullary carcinoma thyroid is Cabozantinib
A 27-year-old female presented with long-standing nodule in right lobe of size 2 cm x 2 cm and underwent right hemithyroidectomy. Histopathological findings are suggestive of Papillary carcinoma

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CARCINOMA OF THYROID MANAGEMENT