DIP Episode 376 - The Clutch Thyroid Cancer Podcast (for Step 1-3)

Okay, welcome. My name is divine. This is episode 376 of the Divine Intervention Podcast. This is going to be a short podcast, but I'm going to call it the Clutch Thyrid Cancer Podcast. Right, so Thyrid Cancer is something we know that's tested very commonly on the USML exams. So it's something I want you to be able to get correct, get right when you see on a test. So let's just go ahead and get started. Again, as for those of you that are going to be taking your USML list up to exams or step three or cumulose level two or three exams within the next seven weeks roughly. I do have an MBME test, taking strategies course coming up on the 21st of March from 2 to 4 30 PM Pacific Standard Time. So that's like 5 to 7 30 Eastern and then I also have a 24 hour comprehensive review course taking place from the 22nd to the 25th of March from 70 PM to 1 PM Pacific Time each day. That's basically from 10 AM to 4 PM Eastern Standard Time. And then for those of you that are taking your USML list up to CK or step three again or cumulose level two or three exams in the summer. I have a 40 75 hours step to CK school. I call it the disk school. It's going to be taking place from mid to 2nd to the 13th. We're going to be meeting for 7 and a half hours each day. I literally meet a personal ice podcast on that. It's going to be capped the 75 hours school at 40 people because again I want to invest in deeply in everyone that is attended.

So if you're interested in any of these things just should be an email through the website and I'll give you some more information. Okay, so let's begin. Right, so we know the thyroid cancer obviously is cancer from the thyroid. Right, that's kind of like the big thing. And many times the thing that tells us that a person has thyroid cancer is that you can pop it on module on the neck. Right, you can pop it on module on the neck. They're like, whoa, what is going on here? Right. Now the thing is the work of a thyroid nodules. It's kind of a smart thing to to know about for exams. Right. We know that when a person has a thyroid nodule, they're like, well, the very first thing you're going to do is to measure the TSH. That's always what you do first because when you measure the TSH, it will help you differentiate if it's a hot nodule or a cold nodule. Right. So if the TSH is low, that means there must be a lot of thyroid hormone around that suppressing that TSH. Right. In that case, that was what we call the hot nodule. Anytime you're going to follow that up by doing a radioactyl iodine optic scan, right, or a rio scan. Some things that call that a thyroid's integrity. And you know, you may see a single focus of increased optic, which will be a toxic adenoma or multiple four side of increased optic, double toxic motor nodule, or you see like the whole thyroid diffusely increased optic, right.

You're thinking of things around the lines of like grieves disease, or you have those are thyroid, or leading amino globulins. And then if you see no optic and the presence of super tender thyroid gland, right, they're probably thinking of the quervines, thyroiditis. Again, remember, the quervines, thyroiditis has many alternate names. They can call it subacute thyroiditis, the colligrant or lomoidosteroiditis on all exams. Right. But many times modules that are hot, right, they don't have my ligament potential. Again, yes, there's some hot nodules that are my ligament. But most times when the presence of hot nodule, we're not really worried about cancer there. But when the nodule is cold, and how do you see that a module is cold, you define a module as being cold, like the fact that when you measure the TSE, right, is normal or increased, then you're like, whoa, that is not good, right. Like a module that, you know, when we know presence of thyroid nodule and presence like you thyroid, so the TSE is normal, or the TSE is high, that's worrisome, right. So, you worry about cancer, although to be honest with you, most times when people have thyroid nodules, it's completely B9. But those cold nodules, we often want to biopsy them so that we can figure out if we're dealing with cancer or not, right. Now, one smart, high-yield thing to keep at the back of your mind is that these cold nodules, after we've done the TSH, the next step on exams is to do an ultrasound.

You always want to do an ultrasound, you'll just give you better visualization of the module, right. And then many times, while you're doing the ultrasound, you can do a fine-dural aspiration of said module. That's many times done by interventional radiology, or just regular diagnostic radiology, and you'll figure out exactly what's going on and send it off to pathology for analysis, right. Now, the thing is, if a person is discovered to have any of these thyroid cancers, what are you going to do? Well, again, many times you're going to do some kind of surgical resection, or you're going to do a resection. But one thing that is fluently high, you'll to keep at the back of your mind, is that after you perform surgical resection, right. The key thing you want to think about is that you want to give that person an I-131 therapy, especially if they have a popularian follicular thyroid cancer, or talk about that in a bit, right. You want to give them I-131 therapy, so that you can completely suppress any metastasis or anything like that. It's actually very high, you'll to know that. You want to be able to suppress every single thing, right. So you give I-131 therapy after surgery, right. I-131 therapy, because remember iodine concentrates and thyroid cells. So if you have thyroid cells in any part of the body, even if it's not in the neck, it's going to concentrate that radioactive iodine, and it's going to kill of the cancer cell. Okay, right.

So, 13 questions they love to test on the exam, right. They can say, what is the biggest risk factor for thyroid cancer? What I would hope you're saying, oh, divine, the biggest risk factor for thyroid cancer is when you have a past history of like neck radiation. So let's see if we see a person suddenly like the informant in the past, and they have to get radiation as kids or whatever. That increases the risk of thyroid cancer, right. Well, you see the NVM Es, they start mentioning places in like Chernobyl or Fukushima, things like that in an NVME question. They're pretty much testing popular thyroid cancer, right. Because remember, again, popular thyroid cancer many times arises in people that have had neck or chest radiation of some sort. And one thing you want to, I guess maybe some key things you want to keep in mind, you know, thyroid cancer is really, you know, I mean, it's obviously not going to ever have amalgensing. And my heart goes out to people that have dealt with cancers in their families. But thyroid cancer has one of the best survivor rates of any cancer, right. Like almost 100% of people that have thyroid cancer survived five years, right. So let's just slowly walk through each kind of thyroid cancer. Well, the very first one you want to keep in mind, right. If they give you a question about a person that has a neck mass, right. Has a neck mass and they tell you that, oh, they do a fine legal aspiration and they find my ligament cells.

What should you be thinking about? The thing is the MVM is what do you do these days? Sometimes they'll write questions like this and they'll put answers that are all correct, papillary, follicular, medallary and a plastic. They'll put all these things. And then you're like wondering, come on, what do I pick? Well, let me tell you how to know what to pick. The way you know what to pick is by going with epidemiology, right. So the thing is, again, that's one of the reasons why I have this podcast on what is the most common cause of XYZ, right. The MVM is sometimes they do these things where they put many causes of the same thing and then they won't give you any clues in the question. But then the right answer is going to be the thing that is the most common, right. If you see a question like this, pick papillary thyroid cancer. Papillary thyroid cancer is the most common kind of thyroid cancer. Many times they also do this with hemophilia. They'll put hemophilia A and B as answers. Hemophilia A, many times is the right answer. But again, notice I'm saying this is when they don't give you clues. So sometimes they can give you clues in a question that will make you pick hemophilia, be instead of hemophilia A. Okay, well, let's continue. So what's the deal with papillary thyroid cancer? Remember, papillary thyroid cancer, right. Again, it's the most common cancer. Usually, it happens in women, right. It happens in women.

And the key thing about papillary thyroid cancer is that it can spread. Well, many times it spreads. The thing is the method of spread of most of these thyroid cancers is actually pretty high. For example, most times papillary thyroid cancer spreads through lymph nodes, right. In fact, many times on physical exam, when people have thyroid cancer, they're spread. You're going to see cervical lymphadenopathy, like cervical or pre-tricule, or like pre-laringeal lymphadenopathy. Again, especially for both the key points that we're listening to today, right. The cervical nodes are the first point of contact for papillary thyroid cancer. Remember, sometimes people that have thyroid cancer, you can mess up their voice, right. Because again, they have involvement of the recurrent gland nerve. That's very high you to know for, for example. So that's something that you can mess up when you're doing any kind of a thyroid surgery. And remember, also, if you're doing thyroid surgery, that's actually the most common cause of hypopar thyroidism, right. Because as you're doing that thyroid surgery, you de-vascularize the parathyroid glands. And that can cause the presence of the tissues to plummet. And that's going to cause hypococemia with an elevated phosphate, right. So again, papillary thyroid cancer, again, when you spread through lymph nodes, it is not spreading mattolymusically. That's high you to know, right.

So when a presence papillary thyroid cancer, you're going to do a lymph node dissection when you're trying to meet the diagnosis, if you suspect that there's metastasis. Although many times these days, you can find meds by doing certain specialized forms of iodine's integrity. Those are nuclear medicines scans. But we're not going to go into the final details of that. That's not for ideology boards. But when a presence papillary thyroid cancer is pressed through lymph nodes, it does not spread through the bloodstream, right. There is a thing that is, again, sometimes they can put certain things like, oh, thyroid dectomy with lymph node dissection. Thyroidectomy without lymph node dissection is an answer on NV Me's. You need to know the right one to pick. You're going to pick the one that says thyroid dectomy with lymph node dissection. Now remember that rule does not apply to follicular thyroid cancer, right. follicular thyroid cancer spreads him atogenously. It does not spread through lymph nodes, right. So many times, if a presence follicular thyroid cancer, you're not going to be doing any kind of lymph node dissection in those people, right. Now again, papillary thyroid cancer, again, most common kind of thyroid cancer. And again, if you take a biopsy of this mass, what are you going to see? Well, I hope you're saying, oh, divine. We're going to see laminated calcifications.

Remember, sometimes they call these things laminated calcifications or laminated laminated L-E-M-E-W-L-E-T-E-D. Laminated calcifications, right. Those are your samoma bodies, right. They're pretty classic, right. I remember some of my bodies are not just found in papillary thyroid cancer. You can find them in many other kinds of thyroid cancer. We can find them in many other kinds of cancers, right. You can find them in meningiomas, right. You can find them in misophiliomas. We can find them in cirrhosis that don't question numbers of the ovary, right. So those are all high-yofins to know for, for example, those things that have someoma bodies, again, laminated calcifications, right. And again, remember, these anti-ofenniide nuclei, right. You also find them on histology, right. You know, it's like nuclear material. You find them in people that have a... people that have a... Papillary thyroid cancer, right. Papillary thyroid cancer. And again, look at the name papillary, right. But whenever you see the word papillary means, like, the thing is organized like palm fronts, right. So like, fingers in a sense, right. That's, again, something I want to keep at the back of your mind, for example, right. And then follicular thyroid cancer. Again, most times, it spreads hematogenously, right. It is probably like this second most common kind of thyroid. It's not probably not. It is this second most common kind of thyroid cancer, right. It loves to spread hematogenously, right.

So it does not spread through lymph nodes. And when it spreads hematogenously, usually the first point of call is the lungs, right. It loves, loves, loves, loves, loves to spread spread to the lungs, right. Now, remember, for people taking step one, you want to make sure you can differentiate between follicular adenoma and follicular carcinoma, right. The thing is, if you have a follicular lesion and it has not broken through the capsule, it's a follicular adenoma. Once it's broken through the capsule, the thyroid capsule, then that means it's inviolate blood vessels. That's going to be a follicular carcinoma, right. Now, it's actually high yield to no-ferending exams, right. The associations with follicular thyroid cancer, right. So what are some of these associations? Well, again, the key things you want to know first is that it spreads hematogenously, right. But second, I want you to keep in mind that this thing has an association with the, you know, like one of these genetic diseases you actually want to know about called cow dyn syndrome, right. Cow dyn syndrome. Cow dyn syndrome, the pathophase there is that you have a mutation in a tumor suppressor gene, it's called P10, PTEN, right. P10, there is a tumor suppressor gene, right. So you have that tumor suppressor gene not working as well as it should. You can have lots and lots of problems, right. It has an association with follicular thyroid cancer.

In fact, I'm going to take a small segue or small detour and discuss this cow dyn syndrome, right. So what are some key things you want to know about cow dyn syndrome for the USML exams. The first thing I want to know is that again, it has a lot of zomod dominant inheritance, right. It has a lot of zomod dominant inheritance. Many times we never see these genetic cancer syndromes. Again, this role does not work for all of them. But it's a nice, approximate rule to know that's accurately about 80 to 90% of cases. These things are usually inherited in an a lot of zomod dominant fashion, right. So again, for people taking step one, remember, it's a mutation in the tumor suppressor gene. It's called the P10 gene, right. PTE, right. PTE and it's like a phosphatase and stuff like that, right. So if that gene does not work, right, your mTOR pathway, because again, our friends at the USML is especially for step one. They love, love, love, love, love, love, they have self-biology, right. So the mTOR pathway will not work. And if it doesn't work, you're going to have trouble with cells undergoing a poptosis, right. You're going to have a ton of cellular proliferation, and that can obviously cause malignancy. Now, the thing is, there is a ton of stuff to know about cow dyn syndrome. But what are the key ones you want to keep at the back of your mind, for example.

Well, the key things you want to keep at the back of your mind, for example, is that these people have a very high risk of breast cancer. In fact, the most common malignancy that develops in people that have cow dyn syndrome is breast cancer, right. Again, as I said, they can also have follicular thyroid cancer, right. And sometimes they can even have some of these skin manifestations, right. So they can have, like, these viral causality, it kind of looks like HPV lesions. They can have it on the mouth, they can have it on the hands, on the fingers, especially, and usually it's bilateral, when it's on the hands on the fingers, right. They can even have cafe or lay spots, right. Cafe or lay spots. Many things, we have those viral cause HPV-like lesions on their skin. Those things are called, they are called triculin, triculin, moments, right. They are called triculin, moments. It's called tric, CHIL, M-W-M-O-M-A-S, right. So tric, CHIL, L-E-W-M-O-M-A-S, right. Triculin moments, right. That's something you want to keep at the back of your mind, right. So again, the thing is, one of the reasons that our friends at the MVM is with love, a topic like this, is because it has many findings in other disorders, right. It has many findings in other disorders. I mean, these people can also have polyps, right. Many of these people can also have polyps.

And to be honest with you, they can also have hyperpigmented lesions on the skin, I mean, on the mouth, just like we would have pudiergers syndrome, right. So that's something you want to keep in mind, right. It literally almost has like findings from pudiergers, right. Hyperpigmented lesions of the lips. It has findings from neurofibromatosis, he has those cafe or lay spots. It has these viral cause lesions, right. So just going to keep these things in mind with cow d'in syndrome. And the key thing, and one key thing to know with cow d'in syndrome is, right, is these people, you know, since these people have very high risk of breast cancers, many times, you're going to start screening them for breast cancer is very early in life, right. Many times you're going to start screening them around like the age of 18 or like, you know, five years before a cancer started in like, in a family member, stuff like that, right. Even this follicular thyroid cancer, you need to screen them for thyroid cancer. Again, many times you started 18 or instead about, you know, five to 10 years before the earliest thyroid cancer diagnosis in their families, right. And most times these people again, because they are so high risk, they have all these colonic polyps, they can develop colon cancer, right. Many times you're going to start screening them at the age of 35, right, for colon cancer, and then you screen every five years after that, right.

And again, many times for these people, we can also have endometrial cancers, right. Again, you see some findings in Lynch syndrome here, colon cancer related and endometrial cancer related. So many times for these people, you're going to start screening them in the renal ultrasound around the age of 40, and then you're going to do it every one to two years, right. So again, these screening things, not necessary for people taking step one, but for those listening to this podcast that are taking step two, see key step three, you absolutely need to know the stuff, right. So there is a screen, you may wonder like define like what does renal ultrasound have to do with endometrial cancer? Well, let me explain, right. Remember when people have these reproductive system malignancies, these things can metastasize, right, to the year-atars. When they metastasize to the year-atars, that's going to cause an obstructive neuropathy, that can cause renal failure. Although that's more under the purview of cervical cancer, but that's something that can absolutely happen in endometrial cancer. So that's why you need to know these things for purposes of exams, right. So again, follicular thyroid cancer, again like I said, spreads in a torg genocille. And then don't forget, if they give you a question about a person, where multiple family members have died of, you know, of a neck mass of thyroid cancer, right.

You want to think about medallary thyroid cancer, remember it's as if you're a immune to A, immune to B. I remember those problems as we're like, you know, with a red gene mutation, right. Remember, in immune to A, you have, you know, thyroid problems, right. Primary hyperparthyroidism, they'll have fucromocytomas, they'll have medallary thyroid cancer, but in immune to B. And again, these things are both inherited in other small dominant fashions. They're going to have, you know, medallary thyroid cancer, fucromocytomas, they're going to have a marphinoid habit, as they're going to be super tall, right. And then they're going to have new choceroid neuromus, right. Those are all things you want to keep at the back of your mind for, for exams, right. And medallary thyroid cancer, the trauma marker is calcetoning, right. Sometimes these people can present with hypocalcemia, one, tisidense of hypocalcemia, right. Remember, when people have a hypocalcemia, they can have like muscle weakness, they can have a prolonged acute trouble on an EKG, right. They can have all these arrhythmias, they can have like many, many different, many, many different problems, right. So you want to keep that in mind, for example. And this, many times if a represents a medallary thyroid cancer, they made a diagnosis, right. And if you don't have a medallary on your stology, remember, those people, if you stain the cancerous tissue with congorate, right.

You're going to see that upper-grimbing birefringens, because calcetoning, which is tumor marker, right, can aggregate and form amyloid, right. Obviously, if you compare the prognosis of medallary thyroid cancer to papillary and follicular, medallary has the worst of those three, right. But if you're looking for the thyroid cancer that has the worst, worst, worst, worst prognosis, you're looking at an aplastic. And here's the deal with an aplastic. It's going to be in an old person on exams. It's simple as that, right. It's going to be in an old person on exams. And I said that papillary spreads through lymph nodes, follicular spreads through, spreads hematogenously. An aplastic loves to spread by just directing vision. He just invades the neck, right. I think most times these people are going to be dead within about six months. The prognosis is awful, awful, awful. And then one last thing I'm just going to throw in here is that, and usually it's going to be an elderly female on exams, right. But it can also be males as well, right. Now the final thing I think I want to throw in here is remember, if they give you a question about a person that has Hashimuro's thyroiditis, right. Hashimuro's, right. Again, these people, they have like a lot of lymphoid cells attacking, attacking, attacking the thyroid gland. Those lymphoid cells that are acting all crazy, unfortunately, they can progress all the way to the person having a lymphoma in the thyroid gland.

So whenever you see a thyroid lymphoma, right. Think about a person that has a past history of Hashimuro's thyroiditis. That's another thyroid malignancy that he can test. You don't find any many resources, but it's certainly high up to know those things for, for exams. Okay, so I'm going to go ahead and stop here. Again, I do offer one and one tutoring for all the USMLE exams. Step one, step two, see case step three, per clinical medical exams, third year, clerkship, shelf exams. And I also offer these USMLE courses, right. Again, like this month, God willing, I'm offering the 24 hours, step two, see case step three course. And also the MBME testing and strategy scores. Again, those run from the 21st to the 25th of March. And then I offer a disc score, right. It's a step two, see case school is a very high level school. Again, I made a podcast on that, listen to that, but it's 75 hours long. It's kept at 40 people. And then I have these podcasts on all the media podcasts apps, right. Apple, Google, Spotify, at least the most for 7150. If you want everything from episode one, episode 376, which is this one, I will encourage you to go ahead and, you know, subscribe to, you know, check on the website, divine intervention podcasts.com. If you actually have a Word Press account, then subscribe. Then whenever I make a new subscribe to my podcast, and whenever I make a new podcast, you get an email notification.

And then also have a You Tube channel, divine intervention, you have some other podcasts and videos. That's where I post the videos that I make. And then finally, I also offer a new website is called the divine intervention, life lessons.com. Divine intervention, life lessons.com is actually also an Apple podcast is called the divine intervention, life lessons podcast, at about two every week. You know, many people have said they love my life lessons. So I just do a Bible based, you know, many of you listen to this podcast, probably normal question. But it's like Bible based teaching 10 to 15 minute podcasts on just common problems that are faced by humanity. So if you're interested in that, feel free to check out, check out the website. So thank you for listening to me today. Have a wonderful rest of your day. Again, this podcast is really high yield. Listen to it, committee to memory, and you'll help you crush your exams. Until next time, have a wonderful day. God bless you. Thank you.

Measure TSH (Thyroid-Stimulating Hormone). This differentiates between hot nodules (low TSH) and cold nodules (normal/high TSH).

Hot nodule. The high local hormone production suppresses pituitary TSH release.

Cold nodule (normal or elevated TSH).

Papillary Thyroid Carcinoma (PTC). The cervical nodes are the first point of contact.

PTC spreads via lymphatics; FTC spreads hematogenously.

Calcitonin. MTC originates from C-cells, which produce calcitonin.

Anaplastic Thyroid Carcinoma (ATC). It is typically found in elderly patients.

Orphan Annie eye nuclei, laminated calcifications (psammoma bodies), and clearing/ground-glass appearance.

Mutation in PTEN gene; affects the mTOR pathway.

Papillary > Follicular > Medullary/Anaplastic.

Ultrasound, followed by Fine-Needle Aspiration (FNA).

Thyroidectomy with lymph node dissection.

Thyroid lymphoma. (Lymphoid cells attacking the gland can progress to lymphoma).

Orphan Annie eye nuclei, laminated calcifications (psammoma bodies), and clearing/ground-glass appearance.

Mutation in PTEN gene; affects the mTOR pathway.

Papillary > Follicular > Medullary/Anaplastic.

Ultrasound, followed by Fine-Needle Aspiration (FNA).

Thyroidectomy with lymph node dissection.

Thyroid lymphoma. (Lymphoid cells attacking the gland can progress to lymphoma).