Thyroid Cancer in Clinical Practice (eBook)

Iain Ross McDougall is Professor of Radiology and Medicine and Acting Director of Nuclear Medicine Division at Stanford University Medical Center, Stanford, USA and has a continued academic and clinical interest in the etiology and management of thyroid cancer. He has written two books and published numerous journal articles and contributed chapters to over 100 books.

Title Page 2
Copyright Page 3
Dedication Page 4
Preface 5
Table of Contents 6
1. Epidemiology and Etiology of Thyroid Nodules and Thyroid Cancers 7
Epidemiology of Thyroid Cancer 7
Summary 9
Etiology of Thyroid Nodules and Cancer 9
Terms and Definitions Related to Radiation, Radiation Doses, and Exposure 9
Radionuclides of Iodine 11
Radiation in Everyday Activities 12
Medical Diagnostic Procedures from External Radiation 12
Medical Diagnostic Procedures from Internal Radiation 12
Medical Therapeutic Procedures Using External Radiation 13
Medical Therapeutic Procedures Using Internal Radiation 14
Medical Occupational Exposure 14
Occupational Exposure in Nuclear Power Plant Workers 14
Other Occupational Exposures 15
War-Time Exposure to Atomic Bomb 15
Exposure from Atomic Bomb Testing 15
Accidental Exposure to Atomic Bomb 15
Accidental Release of Radioadivity from Power Plants 16
Prophylaxis for Radioactive Fallout 16
Genetic Mutations as a Cause of Thyroid Cancer 17
Familial Nonmedullary Thyroid Cancer 18
Chemicals as a Cause of Thyroid Cancer 19
The Role of Iodine in the Etiology of Thyroid Cancer 19
Estrogen and Thyroid Cancer 19
Geographic Factors 19
Summary and Key Facts 20
References 20
2. Thyroid Anatomy and Physiology 23
Gross Anatomy 23
Embryology 23
Blood Supply of the Thyroid 24
Lymphatic Supply of the Thyroid 24
Surgical Anatomy 24
Microscopic Structure of the Thyroid 25
The Sodium Iodide Symporter 25
Carriage of Thyroid Hormones in the Blood 28
Metabolism of Thyroid Hormones 28
Action of Thyroid Hormones 28
Effects of Thyroid Hormones on the Individual 28
Control of Thyroid Function:Hypothalamic-Pituitary-Thyroid Axis 29
Pituitary and Thyroid-Stimulating Hormone 29
TSH Receptor 30
Autoregulation of the Thyroid 31
Testing Thyroid Function 31
References 31
3. Thyroid Nodule 33
Clinical Features 33
Diagnostic Testing 33
Thyroid Scintigraphy 35
Thyroid Ultrasound 36
Fine Needle Aspiration 37
Management of Thyroid Nodule 37
Treatment with Thyroid Hormone 37
Treatment of Autonomous Thyroid Nodule Causing Thyrotoxicosis 37
Cystic Thyroid Nodule 38
Management of Multinodular Goiter 38
Substernal (Retrosternal) Nodular Goiter 40
Summary and Key Facts 40
References 40
4. Thyroid Pathology 43
Fine Needle Aspiration 43
Intraoperative Examination 45
Recent Molecular Advances 45
Benign Thyroid Tumors and Tumor-Like Nodules 45
Nontoxic Multinodular Goiter/Adenomatous Hyperplasia 46
Follicular Adenoma 47
Acute Thyroiditis (Thyroid Abscess) 48
Subacute Thyroiditis 48
Chronic Lymphocytic Thyroiditis (Hashimoto's Thyroiditis) 49
Reidel's Thyroiditis 50
Thyroid Cancers 50
Differentiated Thyroid Cancer: Papillary Thyroid Cancer (Chapter 5) 50
Variants of Papillary Cancer (Chapter 6) 50
Differentiated Thyroid Cancer: Follicular Cancer (Chapter 5) 52
Variants of Well-Differentiated Follicular Cancer (Chapter 6) 53
Poorly Differentiated Carcinoma: Insular Carcinoma (Chapter 6) 53
Anaplastic Thyroid Cancer (Chapter 9) 53
Carcinoma of C Cell Origin: Medullary Thyroid Cancer (Chapter 10) 54
Hematolymphoid Neoplasms (Chapter 11) 54
Mesenchymal Tumors of the Thyroid 55
Metastases to the Thyroid (Chapter 12) 56
Squamous Cell Carcinoma 56
References 56
5. Differentiated Thyroid Cancer 59
Introduction and Presentation 59
Natural History of Differentiated Thyroid Cancer 59
Fundamentals of Treatment 61
Surgery 61
Radioactive Iodine 63
Diagnostic Scanning 63
Recombinant Human Thyrotropin 64
Low Iodine Diet 65
Which Radioactive Tracer? 66
Interpretation of the Whole-Body Scan 66
False-Positive Findings 69
Thyroglobulin 72
Treatment with Thyroid Hormone 73
Treatment with Radioiodine 131I 74
Empiric Therapy for "Ablation of Remnants" 75
Treatment of Metastases: Empiric Therapy 76
Dosimetry to Deliver a Specific Absorbed Radiation Dose to the Cancer 76
Dosimetry Using Diagnostic 124I 76
Dosimetry to Ensure Marrow and Lung and Total-Body Radiation Are Not Excessive 77
Treatment After Stimulation with Recombinant Human Thyrotropin 77
Regulations for Release of Radioactive Patients 78
Side Effects and Complications 78
Posttherapy Scintiscan 80
Follow-Up After Treatment of Cancer 82
External Radiation as an Alternative to 131I 83
Controversies 83
Is 131I Necessary? 83
Stunning? 85
Thyroglobulin-Positive, 131I-Negative Patients 86
Additional Methods of Treatment 89
External Radiation 89
Embolization of Cancer 89
Methods to Induce Redifferentiation of the Cancer 89
Retinoic Acid 89
Lithium 89
References 90
6. Differentiated Thyroid Cancer: Rare Clinical Situations 98
Familial Differentiated Thyroid Cancer 98
Thyroid Cancer and End-Stage Renal Disease 98
Differentiated Thyroid Cancer Arising in Ectopic Sites 99
Cancer in Thyroglossal Tract 99
Cancer in Lingual Thyroid 99
Malignant Struma Ovarii 100
Variants of Papillary Cancer 100
Follicular Variant of Papillary Cancer 100
Tall Cell Variant of Papillary Cancer 101
Columnar Cell Variant of Papillary Cancer 101
Solid (Trabecular) Variant of Papillary Cancer 101
Insular Cancer (Poorly Differentiated Cancer) 102
Variants of Follicular Cancer: Hürthle Cell Cancer 102
References 103
7. Differentiated Thyroid Cancer in Children 106
Incidence 106
Presentation and Diagnosis 106
Pathology 108
Treatment 108
Surgery 108
Thyroid Hormone 109
Radioiodine 109
Radiation Safety 113
Management After 131I Treatment 113
False-Positive Scans 114
Complications and Long-Term Problems After 131I 115
Controversies 116
Prognosis 116
Summary 117
References 117
8. Thyroid Cancer and Pregnancy 121
Thyroid Nodule in Pregnancy 121
Treatment of Thyroid Cancer Diagnosed in Pregnancy 121
Management of Patient with Thyroid Cancer Who Wants to Become Pregnant 124
Effect of 131I on Fertility and Offspring 124
Management of Pregnant Patient with Previously Treated Thyroid Cancer 125
Effects of Cancer on the Pregnancy and Pregnancy on the Cancer 125
Inadvertent Exposure of Pregnant Patient to Internal Radiation 125
Summary and Key Facts 126
References 126
9. Anaplastic Carcinoma of the Thyroid 130
Etiology 130
Pathology 130
Clinical Features 131
Diagnosis 131
Treatment 131
Surgery 132
External Radiation 133
Chemotherapy 133
Multimodality Treatment 134
Radioiodine 134
Summary of Therapy 135
Prognosis 135
Prophylaxis 135
Summary and Key Points 135
References 136
10. Medullary Cancer 138
Etiology 138
Pathology 138
Clinical Features 140
Diagnosis and Genetic Testing 140
Treatment 142
The Role of Postoperative Radiation and Chemotherapy 144
Follow-Up 145
Scintigraphic Tests 145
Selective Venous Sampling 146
Prognosis 146
Summary 146
References 147
11. Primary Lymphoma of the Thyroid 151
Pathology 151
Clinical Features 151
Diagnosis 151
Workup of Patient 152
Management 153
Summary and Key Facts 153
References 153
12. Metastases to the Thyroid 155
Incidence of Metastases to the Thyroid at Autopsy 155
Clinical Importance of Metastases 155
Diagnosis of Metastasis to the Thyroid 156
Treatment of a Metastasis to the Thyroid 157
Prognosis 158
Summary and Key Points 158
References 159
Index 161