THYROID CANCERElizabeth Mellott, Sodexo Dietetic Intern June 2012

THYROID GLAND

http://darylmarxmd.com/web_pages/Thyroid_parathyroid_surgery.htm

Follicular cells secrete tetraiodothyronine (T4) and triiodothyrone (T3)

C Cells secrete calcitonin

Parathyroid glands secrete parathyroid hormone

CANCER

Class of diseases characterized by uncontrolled cell division and ability of the cells to invade other tissues either by direct growth into adjacent tissues (invasion) or by migration of cells to distant sites (metastasis)

Initiation → Promotion → Progression

http://www.sigmaaldrich.com/technical-documents/articles/biofiles/carcinogenesis-and.html

TYPES OF THYROID CANCER

Papillary carcinoma

Follicular carcinoma

Medullary Carcinoma

Anaplastic Carcinomahttp://endocrinesurgery.ucla.edu/patient_education_adm_tst_thyroid_ultrasound.html

RISK FACTORS

Almost all diseases of the thyroid including cancer occur about 3 times more often in women than in men

Exposure to head or neck radiation at a young age

A diet low in iodine Family history of thyroid cancer Risk of thyroid cancer peaks earlier for women

(who are most often in their 40s or 50s when diagnosed) than for men (who are usually in their 60s or 70s)

TREATMENT

Thyroidectomy or Lobectomy External Beam Radiation Therapy Chemotherapy Radioactive Iodine

http://www.medicaltourismco.com/general-surgery/thyroidectomy-surgery-abroad.php

MNT FOR RADIATION

Radiation therapy (RT) is delivered with electromagnetic rays (gamma and x-rays) and charged particles (electrons)

RT to the neck can cause mucositis, xerostomia, dysphagia, odynophagia, and subsequently dehydration.

Eat foods that are easy to chew and avoid hot, spicy, salty, acidic, and sharp, crunchy foods.

MNT FOR CHEMOTHERAPY

Chemotherapy induced nausea and vomiting may begin 24 hours after the administration of chemotherapy, and last up to a week

Encourage patient to take their anti-emetic medications and try 5-6 small meals a day

Avoid favorite foods for several days following treatment

CANCER PREVENTION

Be as lean as possible without becoming underweight

Be physically active for 30 minutes each day Avoid sugary drinks, and limit consumption of

energy dense foods Eat more of a variety of vegetables, fruits,

whole grains, and legumes such as beans Limit consumption of red meats (beef, pork,

lamb) and avoid processed meats Limit alcoholic drinks to 2 for men and 1 for

women a day. Limit consumption of salty foods

http://www.aicr.org/reduce-your-cancer-risk/recommendations-for-cancer-prevention/index.html

PATIENT PROFILE

68 Year Old Caucasian Female Admitting Dx: Acute Renal Failure,

Dehydration, Hypokalemia Allergies: Depo-Medrol, Sulfa drugs,

Adhesive Tape PMH: HTN, dyslipidemia, COPD,

nephrolithiasis, autoimmune hepatitis, PEG, thyroidectomy

Family History: Father-prostate cancer, Sister-breast cancer

DIAGNOSTIC TESTS

Electrocardiogram (EKG) Retroperitoneal Ultrasound Abdominal and Pelvic CT scan Urinalysis

http://www.ct-scan-info.com/ctkidney.html

LABORATORY

MEDICATIONS

Synthroid Oscal with vitamin D Ativan Zofran Protonix Zocor Pepcid Magic Swizzle Sancuso Patch Compazine

Cisplatin Vitamin C Neutra-Phos MagOX Apresoline Prinivil K-Dur

http://www.synthroid.com/WhatIsSynthroid/Default.aspx

http://www.time.com/time/specials/packages/article/0,28804,1855948_1863993_1864005,00.html

NUTRITION THERAPY

Inadequate oral intake related to thyroid cancer with chemotherapy and radiation therapy as evidenced by patient's reported symptoms of nausea and vomiting and existing PEG for nutrition support.

1360-1635 kcals (25-30 kcals/kg) 54 grams protein ( 1 gram/kg) 1635 mL fluid (30 mL/kg)

NUTRITION THERAPY

Recommended Jevity 1.2 @ 50 mL/hr to provide 1440 kcals, 67 grams protein.

For home, Jevity 1.2 @ 120 mL/hr for 10 hours with 220 mL free water three times/day.

Encourage oral intake as patient is able to tolerate to preserve swallowing function.

http://abbottnutrition.com/products/jevity-1_2-cal

QUESTIONS?

REFERENCES

Raykher A, Russo L, Schattner M, et al. Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract. 2007;22:68–73.

Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214.

American Institute for Cancer Research Website. www.aicr.org. Accessed June 14, 2012.

The American Cancer Society website. www.cancer.org. Acessed June 14, 2012.

National Cancer Institute at the National Institutes of Health website. www.cancer.gov. Accessed June 14, 2012.