In 2011, the American Cancer Society estimated that 48,020 new cases of thyroid cancer will be diagnosed in the United States (36,550 in women and 11,470 in men)
CLASSIFICATION of Follicular Thyroid Cancer:
Thyroid follicular epithelial-derived cancers are divided into three categories:
-Papillary cancer
-Follicular cancer
-Anaplastic cancer
Papillary and follicular cancers are considered differentiated cancers and patients with these tumors are often treated similarly despite numerous biologic differences. Most anaplastic (undifferentiated) cancers appear to arise from differentiated cancers.
TREATMENT of Follicular Thyroid Cancer
Once the diagnosis of differentiated thyroid cancer is established, several treatment options may be considered, depending upon the extent of the disease, the patient's age, and the presence of comorbid conditions.
Surgery — Surgery is the primary mode of therapy for patients with differentiated thyroid cancer. We recommend total thyroidectomy if the primary tumor is at least 1.0 to 2.0 cm in diameter, or if extrathyroidal extension or metastases are present. This operation should be performed by an experienced thyroid surgeon to minimize the risk of hypoparathyroidism and recurrent laryngeal nerve injury.
Radioiodine therapy — Radioiodine is the most effective adjuvant treatment for papillary thyroid cancer, in the form of 131-iodine (131-I). Radioiodine causes cytotoxicity by the emission of short path-length (1 to 2 mm) beta radiation. Radioiodine uptake is dependent upon adequate stimulation by TSH, and is reduced by the presence of excess stable iodide. Therefore, whenever radioiodine imaging and treatment are planned, the patient should be instructed to avoid all iodine-containing medications and to limit dietary intake of iodine for at least one week. In addition, the intravenous contrast used for CT scans contains a large iodine load and may interfere with RAI scanning and therapy for several months.
Thyroid hormone suppression — After initial surgery, whether or not radioiodine therapy is administered, we suggestlevothyroxine therapy for all patients to prevent hypothyroidism and to minimize potential TSH stimulation of tumor growth.
Medullary Thyroid Cancer:
Medullary thyroid cancer (MTC) is a neuroendocrine tumor of the parafollicular or C cells of the thyroid gland. MTC accounts for approximately four percent of thyroid carcinomas. A characteristic feature of this tumor is the production of calcitonin. In addition, the C cells originate from the embryonic neural crest; as a result, medullary carcinomas often have the clinical and histologic features of other neuroendocrine tumors such as carcinoid and islet-cell tumors.
Genetic screening in sporadic Medullary Thyroid Cancer (MTC) — Some patients with apparently sporadic MTC have unsuspected germline RET mutations (the underlying defect in MEN2) and, therefore, heritable disease. We therefore agree with the 2009 American Thyroid Association Guidelines for Management of Medullary Thyroid Cancer that all patients with C cell hyperplasia or MTC be offered germline RET testing
Staging of Thyroid Cancer:
STAGING — The pTNM criteria for clinicopathologic tumor staging adopted by The Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC) are based upon tumor size and the presence or absence of extrathyroidal invasion, local and regional nodal metastases, and distant metastases:
Stage I — MTCs that are less than 2 cm in diameter without evidence of disease outside of the thyroid gland
Stage II — any tumor between 2 and 4 cm without evidence of extrathyroidal disease
Stage III — any tumor greater than 4 cm, or level VI nodal metastases or microscopic extrathyroidal invasion regardless of tumor size
Stage IV — any distant metastases, or lymph node involvement outside of level VI, or gross soft tissue extension
SURGICAL THERAPY — Total thyroidectomy is the preferred initial treatment for patients with MTC. Up to 30 percent of patients with sporadic MTC and all patients with inherited MTC have bilateral or multifocal disease
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Thanks uptodate.com
Dr. Brian Kim’s credentials:
Certifications
·American Board of Internal Medicine-Endocrinology Diabetes & Metabolism
Specialties
·Endocrinology, Diabetes and Metabolism
·Internal Medicine
Roles
·Assistant Professor
·Co-Leader, Thyroid Cancer Site Disease Group
Biography
Brian W. Kim, MD, was educated at Harvard College and received his M.D. from the College of Physicians and Surgeons at Columbia University. He did his endocrinology fellowship at Brigham and Women's Hospital in Boston, and subsequently joined the faculty of Harvard Medical School in 2004. Dr. Kim relocated to the University of Miami in early 2009, where he has established a research lab studying the mechanisms underlying thyroid hormone's effects on energy expenditure. His clinical interests focus on thyroid disease, with an emphasis on the treatment of thyroid cancer.
