Devaprabu Abraham, MD, MRCP, ECNU

51 Pages·2015·8.15 MB·English

AACE Advances in Medical and
Surgical Management of Thyroid
Cancer, 2015.
Tampa, Florida.
Dev Abraham MD, MRCP (UK), ECNU
Professor of Medicine,
Division of Endocrinology,
Huntsman Cancer Institute,
University of Utah, Salt Lake City, UT
None
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1.   Discuss the prevalence of DTC
2.   Review of risk factors for thyroid cancer
3.   The debate of increased detection vs
increased incidence
4.   Concerns regarding over-diagnosis and
over- treatment
23 years old lady presents to the ER for
¨ 
evaluation of persistent neck pain following
a whip lash injury sustained in a car wreck
CT scan of the neck was performed
¨ 
Radiology report:
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“Left thyroid lobe contains an ill defined
nodule which is inadequately evaluated by
this examination. Malignancy cannot be
ruled out and a dedicated US study is
recommended”
FNA – “Papillary thyroid cancer”
“I grew up in the 4 corners region - Nevada
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above ground testing, my parents lived all their
lives there. My father died of lung cancer and
my mother has lymphoma”
4 people in the same street have thyroid cancer.
¨ 
Is this the reason?
¨ 
What should I do about my daughter who is 2
¨ 
years old?
Is her risk for cancer increased?
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Family history of thyroid cancer
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¡  Family history: 10 fold increased risk.
¡  Incidence ratio: affected parent - 3.21
¡  Sib – 6.2 and for a female with affected sister 11.1
History of exposure to radiation
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¡  Nodule detected in a patient with history of
radiation: 30 % risk of cancer
¡  Acne, fungal scalp infection, Hodgkin’s, Squamous
head and neck cancers
¡  Nuclear disasters – eg: Chernobyl
Extrinsic Intrinsic
¨  ¨ 
¡  X rays ¡  Elevated TSH (sub-
clinical)
¡  Radiation
¡  Autoimmune thyroid
¡  I131
disease
¡  Iodine supplementation
¡  Obesity and insulin
¡  “Westernized lifestyle”
resistance
¡  Environmental
pollutants – PCBs, BPA,
aromatic hydrocarbons
¡  USA – 80,000 chemicals
are present is various
products – only a few
are even tested