Papillary thyroid carcinoma (PTC) is an epithelial malignancy showing evidence of follicular cell differentiation and distinctive nuclear features. It is the most frequent thyroid neoplasm, it accounts for 80-85% of the cases and carries the best overall prognosis. PTC is also called as “ the good cancer” due to its high survival rates, low recurrence, slow growth and rare distant metastasis. It commonly via lymphatics to cervical lymph node. The 5 year survival rate for PTC is 99%
Etiology
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Exposure to ionising radiations
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Genetics
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Excess dietary iodine levels
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Syndromes like FAP ( familial adenomatous polyposis) COWDENs Syndrome
Prevalence
It is more prevalent in women
Age of presentation
20-55 yrs - aggressive local spread - more common in women
55 and above - large tumours, worse outcome more common in men
Clinical presentation
It presents as asymptomatic painless mass in the neck
Hoarseness in voice ( if recurrent laryngeal nerve gets involved)
Younger patients have higher lymph node involvement
Diagnosis
USG- hypoechoic mass with calcifications
FNAC
CT scan ( aids in assessment of extra thyroidal extension and surgical planning)
Treatment
Thyroidectomy — total or partial
Radio iodine ablation — post surgery for removal or remnants or in metastasis.
Levothyroxine suppression — to keep TSH levels low, preventing pituitary gland from secreting the hormone and starve residual any residual cancer cells of their primary growth stimulus to prevent recurrence.
Follow-up
Yearly USG neck
Anti-thyroglobulin antibodies (TgAb) test ( it should be undetectable)
Event though PTC is called a “ good tumour”, it requires surveillance and life style modifications post surgery. The diagnosis throws a person completely off balance. The normal body functions now depend on a medicine which must be taken at specific time, (to be taken 30 mins before breakfast on empty stomach). Taking TSH on high dosage weakens the bones over time which makes calcium supplementation necessary. Missing a dose means low energy levels for the day.Weight management also becomes difficult process. Although not aggressive or life altering as life after thyroidectomy comes with its own challanges.
MBH/PS