Papillary Thyroid Carcinoma — RACP Adult Medicine MCQ

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EasyEndocrinology & DiabetesPapillary Thyroid CarcinomaRACP Adult Medicine

A 45-year-old woman presents with a painless neck lump. Fine needle aspiration of a thyroid nodule shows nuclear grooves, intranuclear inclusions (Orphan Annie eyes), and psammoma bodies. What is the diagnosis?

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Correct answer: D — Papillary thyroid carcinoma

Nuclear grooves, intranuclear pseudoinclusions ('Orphan Annie eyes'), psammoma bodies, and papillary architecture on FNA cytology are pathognomonic for papillary thyroid carcinoma (PTC) – the most common thyroid malignancy (80–85%). PTC has an excellent prognosis (>95% 10-year survival). Lymph node metastasis is common but does not significantly worsen prognosis. Treatment is surgical (hemithyroidectomy for small tumours <4 cm; total thyroidectomy for larger or bilateral tumours) followed by radioactive iodine ablation and TSH suppression with levothyroxine for higher-risk disease.

Reference: Cancer Council Australia – 2023 – Thyroid Cancer Guidelines; ATA – 2015