Devaprabu Abraham, MD, MRCP, ECNU PDF
Preview Devaprabu Abraham, MD, MRCP, ECNU
AACE Advances in Medical and Surgical Management of Thyroid Cancer, 2015. Tampa, Florida. Dev Abraham MD, MRCP (UK), ECNU Professor of Medicine, Division of Endocrinology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT None ¨ 1. Discuss the prevalence of DTC 2. Review of risk factors for thyroid cancer 3. The debate of increased detection vs increased incidence 4. Concerns regarding over-diagnosis and over- treatment 23 years old lady presents to the ER for ¨ evaluation of persistent neck pain following a whip lash injury sustained in a car wreck CT scan of the neck was performed ¨ Radiology report: ¨ “Left thyroid lobe contains an ill defined nodule which is inadequately evaluated by this examination. Malignancy cannot be ruled out and a dedicated US study is recommended” FNA – “Papillary thyroid cancer” “I grew up in the 4 corners region - Nevada ¨ above ground testing, my parents lived all their lives there. My father died of lung cancer and my mother has lymphoma” 4 people in the same street have thyroid cancer. ¨ Is this the reason? ¨ What should I do about my daughter who is 2 ¨ years old? Is her risk for cancer increased? ¨ Family history of thyroid cancer ¨ ¡ Family history: 10 fold increased risk. ¡ Incidence ratio: affected parent - 3.21 ¡ Sib – 6.2 and for a female with affected sister 11.1 History of exposure to radiation ¨ ¡ Nodule detected in a patient with history of radiation: 30 % risk of cancer ¡ Acne, fungal scalp infection, Hodgkin’s, Squamous head and neck cancers ¡ Nuclear disasters – eg: Chernobyl Extrinsic Intrinsic ¨ ¨ ¡ X rays ¡ Elevated TSH (sub- clinical) ¡ Radiation ¡ Autoimmune thyroid ¡ I131 disease ¡ Iodine supplementation ¡ Obesity and insulin ¡ “Westernized lifestyle” resistance ¡ Environmental pollutants – PCBs, BPA, aromatic hydrocarbons ¡ USA – 80,000 chemicals are present is various products – only a few are even tested
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