Thyroid Neoplasms MCQ — NEET PG Practice Question | NEETPGAI
Thyroid Neoplasms
medium
microscope Pathology
Regarding papillary thyroid carcinoma (PTC), all of the following statements are true EXCEPT:
A. It typically spreads to distant organs early in the disease course, making systemic chemotherapy the primary treatment modality
B. It is the most common thyroid malignancy, accounting for approximately 80% of all thyroid cancers
C. RET/PTC rearrangement is the most frequent genetic alteration, found in up to 70% of cases
D. Lymph node metastases are common at presentation, but prognosis remains excellent with 10-year survival >90%
Explanation
Papillary Thyroid Carcinoma: Distinguishing Features
Key Point
Papillary thyroid carcinoma is an indolent malignancy with excellent prognosis despite frequent lymph node involvement at presentation. The defining feature is its propensity for lymph node metastasis, NOT distant organ spread.
Epidemiology & Genetics
Table
Feature
Details
Frequency
80–85% of all thyroid cancers
Primary genetic alteration
RET/PTC rearrangement (40–70% of cases)
Other mutations
BRAF V600E (25–40%), TP53, PTEN
Age of onset
Peak: 40–50 years; can occur in children
High-YieldNEET PG
RET/PTC is a hallmark of PTC and is particularly common in radiation-induced cases (post-Chernobyl, post-atomic bomb exposure).
Clinical Behavior & Prognosis
1.
Lymph Node Involvement
Present in 20–50% of patients at diagnosis
Central compartment (level VI) involvement is most common
Lateral neck node metastases occur in 10–15% at presentation
Occur in only 1–5% of patients at initial presentation
Lung is the most common site (80% of distant metastases)
Bone, brain, and liver metastases are rare
Late manifestation (years to decades after primary diagnosis)
3.
Why Prognosis is Excellent
Slow growth rate
High sensitivity to radioactive iodine (RAI)
Excellent response to thyroid hormone suppression therapy
Most deaths occur in patients >45 years with distant metastases
Clinical Pearl
A patient with PTC and cervical lymph node metastases should NOT be treated with systemic chemotherapy upfront. The standard approach is total thyroidectomy + central/lateral neck dissection (as indicated) + RAI ablation. Chemotherapy is reserved for RAI-refractory metastatic disease.
Warning
PTC spreads early to distant organs — this is FALSE. PTC is characterized by early lymph node spread but LATE (or absent) distant metastases. This is the defining difference from anaplastic thyroid carcinoma, which spreads widely and early.
Why Option 4 is Incorrect
Option 4 states that PTC "typically spreads to distant organs early in the disease course, making systemic chemotherapy the primary treatment modality." This is fundamentally wrong:
Distant metastases are LATE events (if they occur at all)
Systemic chemotherapy is NOT the primary treatment
Primary treatment is surgery + RAI, not chemotherapy
This option confuses PTC with anaplastic thyroid carcinoma (ATC), which does spread widely and early and requires aggressive multimodal therapy including chemotherapy.
Robbins 10e Ch 24
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