Q) 40 year old lady was on anti thyroid medications which she stopped for 2 weeks. She presented in emergency with high grade fever and hypotension. ( Thyroid Storm) What is not a part of further management?
Thyroid or non thyroid surgery in untreated thyrotoxicosis
Trauma in patients with untreated thyrotoxicosis.
Amiodarone
Iodinated contrast agents
RAI therapy
Management is
Beta blockers
Oxygen and hemodynamic support
IV Lugol iodine
PTU
Corticosteroids
The symptoms of thyroid storm are more intense and severe than typical hyperthyroidism symptoms. They can include severe fever, rapid and irregular heartbeat (tachycardia), elevated blood pressure, restlessness, confusion, agitation, tremors, excessive sweating, nausea, vomiting, diarrhea, dehydration, and in severe cases, even delirium, seizures, and coma.
For patients with disease confned to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. If there is evidence of nodal metastases, gross
disease should be remove
Q) Not an important prognostic factor in Carcinoma thyroid (JIPMER) A. Age B. Completeness of resection C. Multicentricity D. Extra thyroid extension
Ans c
MOst of the papillary carcinoma are multicentric any way
As per AGES And AMES criteria.
HIgh risk - Male. Age more than 40 years, Size more than 4 cm, Capsular or extra thyroid extension, Regional or distant metastasis and poor differentiation
Low Risk - Well differentiated less than 2 cm. Age benefit is extended to 50 yrs in women
Ref ( Sabiston page page 903)
IN younger patients (<45 years old), the presence of lymph node metastases had no effect on the excellent overall survival, but the presence of lymph node metastases increased the risk of death by 46% in patients older than 45
The presence of lymph node metastasis in patients with contained intrathyroidal primary papillary carcinoma also does not affect long-term survival.
If there is gross or microscopic extension of a primary PTC through the thyroid capsule, a poor prognosis and possibly a higher rate of lymph node metastasis may be anticipated.
Q) 40 yr old lady 2X 2 Solitarty thyroid nodule left lobe. FNAC shows classic type of papillary carcinoma . Usg no neck nodes. Management? ( Questions on Surgical Onco - thyroid)
A. Total thyroidectomy B. Total thyroidectomy with Radio active Iodine C. Total thyroidectomy with central compartment neck dissection D. Hemithyroidectomy + follow up