What is ENT - How is RAI administered?
Recombinant human thyroid stimulating hormone (RAI) is administered along with thyroid hormone withdrawal (rhTSH). Compared to thyroid hormone withdrawal alone, studies reveal that rhTSH preserves quality of life and lowers the radiation dose given to the body.
What is ENT - How is anaplastic thyroid carcinoma treated?
At the time of presentation, almost all cases are progressed, and the median survival time is under six months. For palliation and to enhance quality of life, doxorubicin, radiation, and palliative surgery (debulking and airway management) can be taken into consideration. The prognosis is a little bit better for locally contained illness and incidentally discovered anaplastic malignancy.
What is ENT - What is thyroid cancer that is anaplastic?
• Presents as abrupt growth in preexisting mass, associated with discomfort, hoarseness, dysphagia, and dyspnea • Eighty percent occur in preexisting thyroid mass, suggesting malignant de-differentiation within existing tumour
What is ENT - What are the options for treating medullary thyroid cancer?
It is advised to perform TT and neck dissection (if necessary) and consider resecting any other tissues involved. It is advised that MEN II children receive prophylactic TT. Specific gene mutations dictate the age of surgery. Before the age of six months, surgery is advised for the mutations with the highest risk (MEN IIB). Prior to the age of five, surgery is typically advised for mutations with intermediate risk (MEN IIa). Serial serum calcitonin and CEA levels should be monitored over an extended period of time.
What is ENT - . How is the diagnosis of medullary thyroid carcinoma handled?
MEN type II tumour screening should be performed on patients who have the RET mutation: (2) Parathyroid adenoma: serum calcium and parathyroid hormone and (1) pheochromocytoma: plasma fractionated metanephrines and abdomen scan to rule out pheochromocytoma (PTH). Family members ought to undergo genetic testing for MEN type II cancers and the RET protooncogene. Depending on the levels of calcitonin and CEA, imaging should assess both local and distant metastases using computed tomography (CT) or magnetic resonance imaging (MRI). High CEA or calcitonin values suggest distant metastases and may warrant further imaging.
What is ENT - What distinctive features of medullary thyroid carcinoma are significant?
• More aggressive than papillary and follicular thyroid tumours, which have a good degree of differentiation Prostaglandins, histaminases, serotonin, calcitonin, and carcinoembryonic antigen (CEA) can all be secreted by these cells, which are derived from parafollicular or C cells. They also have a high propensity to invade muscle and the trachea and to spread hematogenously to the lungs and viscera (50% at presentation). • MEN IIb type is the most aggressive; familial medullary thyroid cancer has the greatest prognosis, and MEN IIa has an intermediate prognosis. Sporadic unifocal lesions account for 70% of cases, whereas familial/genetic cases account for 30%.
What is ENT - What is the differential diagnosis for hypercalcemia?
Causes of Hypercalcemia
Iatrogenic: Calcium supplementation
Idiopathic infantile hypercalcemia
Benign familial hypocalciuric hypercalcemia
Primary hyperparathyroidism (adenoma, hyperplasia, carcinoma, multiple
endocrine neoplasias I and II)
Parathyroid hormone–secreting tumors (paraneoplastic, mediated by
parathyroid hormone–related protein): small cell lung cancer, ovarian
Multiple myeloma, leukemia, lymphoma
Granulomatous disease: Sarcoidosis, tuberculosis, histoplasmosis, leprosy,
granulomatosis with polyangiitis
Drugs: Thiazide diuretics, lithium, theophylline, hypervitaminosis A and D
Immobilization, total parenteral nutrition
Milk alkali syndrome
Paget’s bone disease, hyperphosphatemia
What is ENT - What is the staging for anaplastic thyroid cancer?
• Stage IV: All anaplastic thyroid tumors are classified as stage IV,
regardless of tumor size, location, or metastasis.
• IVA: Anaplastic tumor that has spread to nearby structures, T4a
• IVB: Tumor that has spread beyond nearby structures, T4b
• IVC: There is evidence of metastasis (any N or M)
What is ENT - What is the staging for medullary thyroid cancer?
Staging for Medullary Thyroid Cancer
Stage I: T1 N0 M0
Stage II: T2–T3 N0 M0
Stage III: T1–3 N1a M0
Stage IVa: T4a, any N, M0 or T1–3 N1b M0
Stage IVB: T4b, any N, M0
Stage IVC: Any T, any N, M1
What is ENT - Multiple endocrine neoplasia is defined as?.
Several diverse disorders characterised by malignancies of the endocrine glands fall under the umbrella term "multiple endocrine neoplasia" (MEN), each with its own unique hallmarks. • MEN type I: pancreatic, pituitary, parathyroid adenomas • MEN type IIa: medullary cancer of thyroid, pheochromocytoma, parathyroid hyperplasia • MEN type IIb: MEN IIa and mucosal neuromas; no parathyroid involvement
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