Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is
Medullary carcinoma thyroid
Follicular carcinoma thyroid
Thyroid adenoma
Multi nodular goitre
Answer is A (Medullary Carcinoma thyroid) Presence of thyroid nodule along with palpable cervical lymph nodes and amyloid histologically is clearly indicative of Medullary variety of Carcinoma Thyroid. Medullary Carcinoma thyroid : It is a neuroendocrine carcinoma rising from parafollicular 'C' cells of thyroid Parafollicular 'C' cells are derived from neural crest and secrete calcitonin. Medullary carcinoma should be suspected whenever : a. High level of serum calcitoninQ are discovered b. Cervical lymph node are discovered at time of presentation. Q - Involvement of lymph nodes occurs early.Q - Thyroid and blood born metastasis occurs early.Q c. DiarrheaQ is a presentation d. AmyloidQ is present in stroma histologically. e. MEN setting : Evidence of Pheochromocytoma / Hyperparathyroidism / Thyroid cancer in family. (Discovery of medullary carcinoma thyroid makes family surveillance advisable).ef Hypocalcemia is associated: These cancers are associated with HypocalcemiaQ because calcitonin is secreted. Medullary carcinoma thyroid is seen as ? Sporadic : 80% Familial : 20% - Non MEN setting / MEN II a / MEN II b