1. Thyroid malignancies – Our experience
Dr. Satish chandra T
Associate professor
Dr P S I M S & RF

2. Introduction 157 thyroid surgeries over 7 yrs 34 malignancies – 20%
Age range from 14 yrs to 74 yrs
32 operable, 2 inoperable (anaplastic, bony metastasis papillary)

3. Types of surgeries
Hemithyroidectomy follwed by completion thyroidectomy 6
Total thyroidectomy 16
Total thyroidectomy with neck dissection. 10

4. Clinical presentation
Most common presentation swelling in thyroid - 20
Vocal cord paralysis without thyroid swelling - 1
Isolated lymphnode swelling - 1
Thyroid swelling with lymphnodes – 9
Thyroid swelling with distant metastasis - 1
Family h/o – 2

5. FNAC Follicular neoplasm 7 Papillary carcinoma 21 Medullary carcinoma3
Anaplastic 1
Multinodular goiter 2

6. HPE diagnosis Papillary carcinoma 23 Medullary carcinoma 3
Follicular carcinoma 6
Anaplastic 1

7. FNAC / HPE Useful screening test for planning False negatives - low
Sensitivity – high except for follicular carcinoma
6 cases – second surgery ( completion thyroidectomy)

8. Preop Thyroid profile FNAC Other routine investigations
U/S to rule out non palpable nodules
CT scan in suspicious malignancy

9. surgery Usually under GA
Special conditions (not fit for GA) – regional block (2 cases)
Pedicles
Identify the nerve, parathyroid
Drain

10. Post op Usual hospital stay for 6 days I V antibiotics for 2 days
Calcium supplementation in total thyroidectomy cases for 1 week
Thyroxin supplementation from post op day 1

11. Contd- All cases – i131 scan after 45 days
One case showed minimal remnants in thyroid bed – were ablated simultaneously
Post op I131 irradiation

12. Complications
Immediate post op stridor – laryngeal oedema + arytenoid dislocation (recovered in 36 hours)
Managed with reintubabtion
RLN transient palsy in 3 cases (recovered)

13. Outcome Of all the 32 operated malignancy patients 31 were doing well
One patient with medullary carcinoma of age 74 yrs, operated twice for the neck secondaries – died during follow up

14. Interesting cases Micro papillary carcinoma Medullary carcinoma
Papillary carcinoma with jugular invasion
( tumor emboli)
Papillary with bone metastasis
Presentation as isolated vocal cord paralysis

18. Papillary carcinoma (occult) of thyroid with neck secondaries

22. Medullary carcinoma Female patient of age 23with neck swelling
Husband who happens to be her first cousin died 4 months back with similar swelling some other hospital
She was operated and doing well
Father in law, who is her maternal uncle developed thyroid swelling after 2 yrs at the age of 72
Did total thyroidectomy with neck clearance
Neck recurrence after 18months
Neck clearance done
After 12 months he developed axillary nodes with symptoms of hyper calcitonin levels, lost the patient after a month
She is having a daughter of 9 yrs age – what to do?

25. Tumor emboli in internal jugular vein
31 years female patient with thyroid swelling
Neck nodal swelling in level 2
Fnac – papillary carcinoma
Ultrasound with Doppler – right internal jugular vein shows emboli at the level of carotid bifurcation
Ct scan with contrast - thyroid selling with neck nodes and non enhancing internal jugular vein on right side
Total thyroidectomy with Mrnd type 1
Hpe of tumor emboli – papillary carcinoma in IJV

27. Vocal cord paralysis - evaluation
Female patient 52 yrs - hoarseness of voice
O/e left vocal cord paralysis
Examination of neck and chest wnl
Ultrasound neck - mild enlargement of left thyroid lobe
Ct scan of neck with contrast - a nodule in the left lobe of thyroid, in tracheo esophageal groove area
Fnac – inconclusive after repeated efforts
Hemithyroidectomy – lesion directly involving the nerve
Hpe – papillarycarcinoma

31. Thank you