- There are 3 types of airway obstruction
- Central – trachea and main stem bronchi
- Malignancy is most common cause, usually non-small cell lung cancer. Mets from other cancers and local compression from local cancers, including thyroid, are still rare causes
- Upper – Nasopharynx, larynx down through proximal trachea
- Lower – smaller airways, usually due to COPD/asthma
- Central and upper can co-exist, but lower is usually not associated with the other two
- Visualization with bronch or laryngoscopy is usually needed for diagnosis. Tissue biopsy is also usually required, but imaging alone can sometimes be sufficient
- Most patients with papillary thyroid cancer do not die of their disease. However, age >45 at diagnosis, large tumor size and soft tissue invasion and/or metastases increase mortality rates.
- Recurrence of disease is quite common among all age groups and occurs in nearly 15%
- Surgery is the main treatment modality and most patients will have a total thyroidectomy if their tumor is >1cm in diameter and/or they have local or distant metastases.
- TSH suppression goals depend on risk of recurrence. For low risk disease, the TSH goal in 0.1-0.5. For intermediate or high risk, the goal is <0.1 (undetectable)
- Central – trachea and main stem bronchi
Evernote link: https://www.evernote.com/shard/s300/sh/46a2866b-45c9-4cd4-90b4-d7434859e324/92e7f0d3f8c2374eb2bf6dc25f73f27e
Sherman SI, Angelos P, Ball DW, et al. Thyroid carcinoma. J Natl Compr Canc Netw 2007; 5:568.
Sam also shared a helpful resource for looking up treatment guidelines for just about any malignancy. Here is the link to the National Comprehensive Cancer Network guidelines page for future reference!
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site
Advertisements
