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cancers It usually presents as a single nodule, but it can arise out of a multinodular goiter Papillary thyroid carcinoma is commonly multifocal within the gland, with other foci usually arising de novo rather than representing intraglandular metastases Papillary thyroid carcinoma is caused by certain genetic mutations or translocations Activating mutations of the ras oncogene can cause benign thyroid adenomas or nodular goiter Additional activating mutations in BRAF or TRK genes can lead to papillary carcinoma About 45% of papillary thyroid carcinomas are caused by overexpression of the ret oncogene by the translocation of certain gene promoters to it, producing retPTC-1, retPTC-2, or retPTC-3 Radiation treatments to the head and neck region tend to cause retPTC-1 Nuclear fallout exposure tends to cause retPTC-3, resulting in more aggressive papillary thyroid carcinomas Additional loss of the p53 tumor suppressor gene can cause progression of papillary thyroid carcinoma to anaplastic thyroid carcinoma Exposure to radiation therapy to the head and neck poses a particular threat to children who then have an increased lifetime risk of developing thyroid pathology, including papillary thyroid carcinoma; thyroid malignancy may emerge between 10 and 40 years after exposure, with a peak occurrence 20 25 years later After an explosion at the Chernobyl Nuclear Plant in the Ukraine in 1986, the risk of developing papillary thyroid carcinoma was highest among children who were under age 5 at the time of exposure to radiation; emergence of more aggressive papillary thyroid carcinoma occurred within 6 7 years after exposure Papillary thyroid carcinoma can occur in rare familial syndromes as an autosomal dominant trait, caused by loss of various tumor suppressor genes Such syndromes (with associated features) include familial papillary carcinoma (with papillary renal carcinoma); familial nonmedullary thyroid carcinoma; familial polyposis (with large intestine polyps and gastrointestinal tumors); Gardner s syndrome (witlh small and large intestine polyps, fibromas, lipomas, osteomas); and Turcot s syndrome (with large intestine polyps and brain tumors) Older patients with multinodular goiter may rarely.

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Kessler A et al Accuracy and consistency of fine-needle aspiration biopsy in the diagnosis and management of solitary thyroid nodules Isr Med Assoc J 2005 Jun;7(6):371 3 [PMID: 15984379] Liebeskind A et al Rates of malignancy in incidentally discovered thyroid nodules evaluated with sonography and fineneedle aspiration J Ultrasound Med 2005 May;24(5):629 34 [PMID: 15840794] Nam-Goong IS et al Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings Clin Endocrinol (Oxf) 2004 Jan;60(1):21 8 [PMID: 14678283]

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You can change the shell that Terminal uses by selecting Terminal Preferences and clicking the Shell option in the Preferences dialog box (see figure 2.2). Once you choose a shell, you can customize it in the usual manner. For example, I use

Painless swelling in region of thyroid Thyroid function tests usually normal Past history of irradiation to head and neck region may be present Positive thyroid needle aspiration

The incidence of papillary and follicular (differentiated) thyroid carcinomas increases with age The female:male ratio is 3:1 In the United States, thyroid cancer is diagnosed in nearly 26,000 people yearly, and about 1 in every 250 people eventually receives this diagnosis About 13% of persons in the United States are found to have microscopic thyroid cancer at autopsy Clearly, most thyroid cancers remain microscopic and indolent However, larger thyroid cancers (palpable or 1 cm in diameter) are more malignant and require treatment Papillary thyroid carcinoma is the most common thyroid malignancy (Table 26 7) Pure papillary or mixed papillaryfollicular carcinoma represents about 80% of all thyroid

The second reason for using braces is to avoid a common error: adding a second statement to the if and forgetting to add the braces. Consider the code shown in Example 5-4. The programmer has changed the value of valueThree to 10 and added a second statement to the second if block, as shown in bold.

Papillary Incidence Average age Females Deaths due to thyroid cancer Invasion Juxtanodal Blood vessels Distant sites Resemblance to normal thyroid

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