Snapshot A 36-year-old woman complains of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noted a change in her voice and she has difficulty swallowing solids. On PE there is a palpable, nontender swelling in the front of her neck that moves with swallowing. There is not cervical lymphadenopathy. Lab studies show hypercalcemia. An X-ray of the cervical region shows irregular calcifications in mass, while an MRI of the abdomen shows confirms the presence of bilateral adrenal lesions. Follicular Adenoma Introduction most common benign thyroid neoplasm Evaluation radioactive iodine imaging cold nodule histology complete capsular confinement Prognosis small minority progress to follicular carcinoma Papillary Adenocarcinoma Introduction 90% of all thyroid cancers female dominance often multifocal risk factors include radiation exposure to the head and neck Evaluation histology psammoma bodies (calcifications) also seen in ovarian dysgerminomas and meningiomas ground glass/empty nuclei nuclear grooves cells organized into papillary "fingers" Treatment thyroidectomy + iodine radiotherapy Prognosis metastasis via lymphatics very good prognosis Follicular Carcinoma Introduction usually unifocal cold nodule Evaluation histology preservation of normal thyroid follicular architecture but proliferation uniform follicles may invade capsule or blood vessels cannot distinguish follicular adenoma from carcinoma upon biopsy need surgical excision to see invasion into vessels and capsule Prognosis hematogenous metastasis lungs most common good prognosis Medullary Carcinoma Introduction derived from calcitonin synthesizing C cells presentation may be hypocalcemia may also produce ACTH 10% of the cases are familiar and associated with MEN IIa or IIb associated with a RET mutation 90% are sporadic. risk factors for malignancy are previous irradiation of the neck, cold nodules, and family history. Evaluation serum calcitonin tumor marker histology amyloid (consisting of calcitonin) pentagastrin infusion hyperplasia present with high calcitonin level response following administration B-cell Malignant Lymphoma Introduction sequelae of Hashimoto's thyroiditis Anaplastic Thyroid Cancer Introduction seen most commonly in the elderly may be superimposed on multinodular goiter, follicular cancer Prognosis very poor prognosis