THYROID CANCER

DEFINITION: Thyroid gland tumors are divided into benign and malignant. In the first case we are dealing with solitary or multiple nodules that can only cause problems hyperthyroidism or compressive. In the second case , i tumori maligni , can spread by contiguity to the trachea , all'esofago , the muscles of the neck or recurrent nerve or to metastasize via the blood that is lymphatic. The most common malignancy is followed by papillary carcinoma follicular carcinoma while the other varieties hold only 10% delle malignant neoplasia.

ETIOLOGY: The rate of malignancy in nodules is higher in young compared to adult and childhood. The thyroid carcinoma more frequent in the elderly and in the male. There is some inheritance especially in medullary carcinoma.

SYMPTOMS: I noduli tiroidei possono essere asintomatici ma anche dare stati di ipertiroidismo caratterizzati da dimagrimento e tachicardia in questo caso solo eccezionalmente maligni.. In some rare cases may compress the trachea and esophagus. The progressive growth of a nodule over time is an indication of probable malignancy. The pain of sudden onset is usually due to bleeding in cystic lesion, but if associated with progressive increase in volume of the nodule is suspicious for ca. or anaplastic lymphoma of the thyroid. Dry cough and hoarseness in the absence of massive struma, propendono per sospetto di neoplasia invasiva con paresi delle corde vocali.

DIAGNOSIS : Sometimes the detection of thyroid nodules is random in the course of other investigations such as Doppler ultrasound TSA , Rx the Tac toraco. Normalmente la diagnosi è inizialmente clinica (Visit Specialist) , confirmed by ultrasound that will evaluate certain characteristics such as size of the nodule , hyper / hypo / anecogenicità , vascularization , microcalcifications , regularity of the margins , increase in size and by the method elaxto , available in the latest generation of ultrasound , consistency , important element for the first differentiation between benign and malignant nodules. If the nodule present sonographic features of tranquility with dimensions less than one centimeter will be checked after 1 year , otherwise we will proceed with the investigation of the second level as scintigraphy and fine-needle aspiration. It will always be necessary to evaluate FT3 , FT4 , TSH , Calcitonin, and antibodies. In case of positive needle aspiration will be made chest X-ray , tac neck chest with contrast.

TREATMENT: Malignant tumors of the thyroid are always treated surgically. The hyperfunctioning thyroid nodules require drug therapy.

COMPLICATIONS: Complications of the disease are the already mentioned compressions tracheo oesophageal (rare) e le metastasi ( mainly to the lung and lymph nodes of the neck).

SURGERY thyroidectomy

Indications for surgery

The indication for intervention is always in the presence of a malignant tumor diagnosed with fine needle aspiration or in the case of compression or tracheal deviation symptomatic , while it is to be assessed in case of nodular volumetric rapid growth or in the presence of subjective complaints dysphagic and compressional or with clinical features and / or ultrasound suspicious and in the presence of cytology repeatedly inadequate. For a lump associated with hyperthyroidism and cardiotossicosi ( Plummer's adenoma) the treatment of choice is surgical or alternatively radio metabolic , also Graves' disease resistant to drugs should be treated surgically.

Results

L’obbiettivo dell’intervento è l’eliminazione del tumore il più precocemente possibile. Fortunately, thyroid cancer metastasizes less quickly than other tumors. In other cases, the surgery has the function of correcting a hormonal imbalance symptomatic.

The intervention

Usually carried out under general anesthesia and includes total thyroidectomy ( removal of all of the thyroid) , lobo istmectomia ( removal of one lobe and the isthmus) , subtotal thyroidectomy ( removal of the thyroid gland leaving a residue). The lobe-isthmusectomy is indicated for nodular disease for unilateral. The Total thyroidectomy for multinodular goiter and carcinomas in which , in selected cases , is useful linfoadenectomia.Da a few years there is a technique videoassisted , MIVAT that with some limitations indication does not offer any advantage over the usual technique. The scar usually in a matter of time remains almost invisible.

Conclusions relating to the intervention

• Duration intervention: 60 – 90 my
• Type of anesthesia: General
• Dressings: 2
• Length of stay: 2 gg
• Resumption of normal activities: 7 gg