Thyroid Carcinoma, Papillary

Solitary

Step 1: View clinicals

A 60 year old woman presents with a painless neck lump for 3 months. There was no history of recent rapid enlargement, voice changes or discomfort in swallowing. Her medical history is unremarkable and she is not on any medications.


Step 2: Order all relevant investigations

Ultrasound of Lump

The lump appears to be a hyperechoic upper jugulodigastric node 4.1 x 3.2 cm in size, with a sharp border, peripheral vascularity and punctate calcification, but no intranodal necrosis. No other enlarged lymph nodes are seen.

Ultrasound Thyroid

The superior pole of the right lobe contains a solid, ill-defined, hypoechoic nodule 8 mm in diameter, with punctate calcifications.

Imaging guided FNAC

Cytology of the lump: suggestive of nodal metastasis of papillary thyroid cancer Cytology of the thyroid nodule: Thy 5 category (definitely malignant)

Serum Thyroglobulin

The serum thyroglobulin level is 10 ng/ml (normal: ≤ 33)


Step 3: Select appropriate management

Total Thyroidectomy
B/L Radical Block Dissection
External Beam Radiotherapy
Thyroxine


Score: ★★☆