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4 Types, Clinical Manifestations and Management of Thyroid Carcinoma

Thyroid carcinoma including malignant disease group with a relatively good prognosis, but clinical propagation are difficult to predict. Clients with Thyroid Ca experiencing high stress and anxiety. Nurses obtain basic data on the client based on the level of knowledge of the disease, coping skills and family relationships. The nurse encourages the client to express their fears and discuss the disease.

Histological

According to WHO, malignant epithelial tumors of the thyroid are divided into:
  • Follicular carcinoma.
  • Papillary carcinoma.
  • Medullary carcinoma.
  • Poorly differentiated carcinoma (anaplastic).
  • Others.
According to Mc Kenzi (1971), there are 4 types of different thyroid carcinoma tissues used for day-to-day implementation, namely:
  • Papillary thyroid carcinoma.
  • Follicular thyroid carcinoma.
  • Medullary thyroid carcinoma.
  • Anaplastic thyroid carcinoma.
The initial clinical manifestations of thyroid carcinoma is a form of solitude and a nodule in the thyroid gland that is painless. Signs and symptoms depend on the presence or absence of additional metastases as well as the location of metastases (spread of cancer cells) itself.


1. Papillary carcinoma.
Is a type of thyroid cancer that is often found, much to the women or the age group above 40 years. Papillary carcinoma is a slow-growing tumor and can appear many years before spreading to regional lymph nodes. When the tumor is localized in the thyroid gland, the prognosis is good if the action is a partial or total thyroidectomy.

2. Follicular carcinoma.
There is approximately 25% of all existing thyroid carcinoma, especially regarding the age group above 50 years. Attack the blood vessels which then spread to the bone and lung tissue. Rarely spread to the lymph nodes but can be attached / stuck in the trachea, neck muscles, large blood vessels and skin, which then causes dyspnea and dysphagia. When a tumor on "The recurrent laryngeal Nerves", the client becomes hoarse voice. The prognosis is good if the metastases are still little, at the time of diagnosis set.

3. Medullary carcinoma.
Arising in the thyroid parafollicular tissue. The number of 5-10% of all thyroid carcinomas and generally the people aged over 50 years. Spread past the lymph nodes and invade surrounding structures. These tumors often occur and are part of the Multiple Endocrine Neoplasia (MEN) Type II is also part of the endocrine diseases, in which there is excessive secretion of calcitonin, ACTH, prostaglandins and serotonin.

4. Anaplastic carcinoma.
The tumor is growing quickly and outstanding aggressive. This type of cancer directly invading adjacent structures, which give rise to symptoms such as:
  • Stridor (sound raspy / hoarse voice sounded loud breath)
  • Hoarseness.
  • Dysphagia.
The prognosis is bad and most of the clients died about 1 year after diagnosis set. Clients with a diagnosis of anaplastic carcinoma can be treated with palliative surgery, radiation and chemotherapy.


Clinical Manifestations of Thyroid Carcinoma

Clinical suspicion of thyroid carcinoma is based on the observation that was confirmed by pathological examination and suspicion are divided into high, medium and low. Which includes high index of suspicion is:
  • History of multiple endocrine neoplasia in the family.
  • Rapid tumor growth.
  • Palpable hard nodules.
  • Fixation surrounding area.
  • Paralysis of the vocal cords.
  • Enlargement of the regional lymph nodes.
  • The presence of distant metastases.

Moderate suspicion:
  • Age less than 20 years, or more than 60 years.
  • History of neck radiation.
  • Sex man with a solitary nodule.
  • It is not clear fixation surrounding area.
  • Diameter greater than 4 cm and cystic.
Low suspicion:
  • Signs or symptoms outside / in addition to that mentioned above

Thyroid carcinoma clinically divided into classes, namely:
  • Infra Thyroid.
  • Neck glands Spleen metastasis.
  • Extra Thyroid invasion.
  • Far metastasis.
Clinical symptoms that can be found around the organs suppression, disruption and pain when swallowing, difficulty breathing, hoarseness, cervical lymphadenopathy and distant metastasis can occur. Most often to the lungs, bones and liver.

Management of Thyroid carcinoma
  1. Surgery (thyroidectomy).
  2. Radiation internal / external.
  3. Chemotherapy.
  4. Hormonal.
  5. Others.


Evaluation

Made by examining fingerprints all over the body, combined with examination tiroiglobulin levels (Tg) serum periodically in the first 3-6 months. Tg is influenced by TSH and is likely to increase if there is residual thyroid gland. Tg levels less than 1 ng ml during the hormone was stopped, suggesting ablation therapy has been successful. Tg is considered as a sign of thyroid carcinoma is quite sensitive but not specific. The level of calcitonin for medullary carcinoma is an indication of metastasis.
Periodic evaluation is very important because thyroid carcinoma which has been declared successful ablation after 5-10 years turns malignant process could arise again. Recommended control 1 year for the first 5 years after total ablation declared successful, then once every 2 years.

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