Neoplasia of the Thyroid

the most common adenoma >> follicular (highly differentiated, autonomous),

other forms include papillary and Hürthle

Note:

An activating missense mutation in codon 600 of exon 15 (V600E) of BRAF gene has been identified in multiple neoplasms including melanoma, colorectal carcinoma, papillary thyroid carcinoma, hairy cell leukemia, and Langerhans cell histiocytosis.

Ca Thyroid (never hyperfunctioning)

Papillary is the most common (60-70%)

asso: w/ h/o radiation exposure

2-3 times more common in women

bimodal frequency (2nd-3rd decades and later in life)

slow growing, lympatic spread (rarely spread beyond head and neck)

calcifications on X-ray s/a psammoma bodies

FNAB shows large cells with ground glass cytoplasm, and pale nuclei with inclusion bodies and central grooving.

Unencapsulated

Tx: small limited/ localized - surgery

large - radiation and surgery

TSH suppression with levothyroxine also

Excellent prognosis

Follicular (15%)

more common in elderly