Malignant Thyroid ABSITE and Board Review

ABSITE and board review for malignant thyroid cancer. See the benign thyroid video separately for anatomy and physiology. This is targeted for medical students and surgical residents.
Corrections and additions: I had our ENT surgeon review this and these are some corrections:
0:50: We usually isolate & ligate the superior & inferior pole vessels before finding RLN because it makes it easier to rotate the gland medially & expose the tracheoesophageal groove.
3:10: Many thyroid surgeons now check post-op PTH to risk stratify patients for hypoCa & start them on an appropriate protocol depending on the results. Some people who do total thyroidectomy outpatient opt for treating all total thyroids with a calcium protocol that has some leeway for inc. Tums PRN numbness or tingling.
5:15: I don't think recent data supports a survival benefit for total thyroidectomy in greater than 1 cm well differentiated cancers. A lobectomy is thought to be oncologically adequate surgery for less than 4 cm PTC or follicular if it is confined within the thyroid, not multifocal, without involved lymphadenopathy, & has no other high grade features. We consent all lobes for poss. total & poss. central neck dissection. Intra-op extrathyroidal extension or unexpected central lymphadenopathy would indicate a total needs to be performed despite pre-op plans. Sometimes we also get final path back & note high risk features (i.e. tall cell variant PTC or multifocality) & that can push us to recommend completion thyroidectomy at a later date with the benefit of RAI post-op & better monitoring for recurrent with Tg.
6:15: We do not do elective central neck dissection except for MTC. For PTC & follicular, it is only performed if there is clinically evident LAD on pre-op imaging or intra-op when we explore & inspect the central neck/upper mediastinum. One caveat is if someone has lateral neck disease & you are doing a total & lateral neck, then you should also do a central regardless of known LAD at that level. That being said, we usually do find some intra-op in that setting even if it was not noticed on pre-op imaging.
9:16: Extrathyroidal extension is also an indication for RAI.
Outline:
1. Thyroidectomy surgery
a. Nerve monitor
b. Postop complications
c. Calcium monitor
2. Papillary Thyroid Cancer
a. Path and risk factors
b. Surgery
c. TNM stages
3. Follicular Thyroid Cancer
a. Surgery for follicular
4. Radioactive iodine treatment
5. Thyroglobulin
6. Hurthle Cell Variant
7. Medullary Thyroid Cancer
a. Genetic mutations
b. Surgery
8. Anaplastic Thyroid Cancer
References and pictures:
Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why? Thyroid. 2017 Jun;27(6):751-756. doi: 10.1089/thy.2017.0102. Epub 2017 May 19. PMID: 28463585; PMCID: PMC5467103.
Shirley LA, Jones NB, Phay JE. The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer. Front Oncol. 2017 Jun 19;7:122. doi: 10.3389/fonc.2017.00122. PMID: 28674675; PMCID: PMC5474838.

[@venturasurgeryschool796]

Corrections and additions: I had our ENT surgeon review this and these are some corrections:
0:50: We usually isolate & ligate the superior & inferior pole vessels before finding RLN because it makes it easier to rotate the gland medially & expose the tracheoesophageal groove.
3:10: Many thyroid surgeons now check post-op PTH to risk stratify patients for hypoCa & start them on an appropriate protocol depending on the results. Some people who do total thyroidectomy outpatient opt for treating all total thyroids with a calcium protocol that has some leeway for inc. Tums PRN numbness or tingling.
5:15: I don't think recent data supports a survival benefit for total thyroidectomy in greater than 1 cm well differentiated cancers. A lobectomy is thought to be oncologically adequate surgery for less than 4 cm PTC or follicular if it is confined within the thyroid, not multifocal, without involved lymphadenopathy, & has no other high grade features. We consent all lobes for poss. total & poss. central neck dissection. Intra-op extrathyroidal extension or unexpected central lymphadenopathy would indicate a total needs to be performed despite pre-op plans. Sometimes we also get final path back & note high risk features (i.e. tall cell variant PTC or multifocality) & that can push us to recommend completion thyroidectomy at a later date with the benefit of RAI post-op & better monitoring for recurrent with Tg.
6:15: We do not do elective central neck dissection except for MTC. For PTC & follicular, it is only performed if there is clinically evident LAD on pre-op imaging or intra-op when we explore & inspect the central neck/upper mediastinum. One caveat is if someone has lateral neck disease & you are doing a total & lateral neck, then you should also do a central regardless of known LAD at that level. That being said, we usually do find some intra-op in that setting even if it was not noticed on pre-op imaging.
9:16: Extrathyroidal extension is also an indication for RAI.

[@ahmedalshabani6234]

You are amazing doctor please can you explain peadiatric surgery in one videos and shock chapter professor keep going also vascular chapter all that under graduated expaining

[@superfresh75]

Good video. Had one post op hematoma in residency and re intubation was difficult.