Thyroid cancer - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Thyroid cancer most commonly presents as an asymptomatic thyroid nodule detected by palpation or ultrasound in women in their 30s or 40s.
The most important diagnostic test is fine-needle aspiration.
Treatment of differentiated (papillary, follicular) thyroid cancer and Hürthle cell carcinoma depends on pretreatment assessment of risk and usually includes total thyroidectomy or lobectomy. Risk adjustment based on surgical and pathologic findings determines if radioactive iodine ablation, thyroid-stimulating hormone (TSH) suppression, or both is indicated.
Treatment differs and must be tailored for uncommon types of thyroid cancer such as anaplastic, medullary, or primary thyroid lymphoma.
Prognosis depends on risk-group stratification.

Histopathology of papillary carcinoma, thyroid: a psammoma body is visible (arrow)

CDC Image Library/Dr Edwin P. Ewing, Jr

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Histopathology of papillary carcinoma, thyroid: a psammoma body is visible (arrow)
Histopathology of follicular carcinoma, thyroid
Hürthle cells with abundant granular, eosinophilic cytoplasm and 'cherry pink' nucleoli
Hürthle cell carcinoma: presence of tumor cells within a vein, indicative of vascular invasion
Medullary thyroid cancer: H&E stain showing nests of tumor cells
Medullary thyroid cancer: calcitonin stain
Skull x-ray showing extensive metastases from follicular thyroid carcinoma
Increased uptake of radioiodine in both pulmonary fields and the mediastinum due to miliary lung metastasis from papillary thyroid carcinoma
CT of neck pre- and post-operative: tracheal compression by a thyroid lymphoma

Citations

Key Articles

Haugen BR, Alexander EK, Bible KC, et al; American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133.[Abstract][Full Text]
Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610.[Abstract][Full Text]
Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: thyroid disease. 2019 [internet publication].[Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma [internet publication].[Full Text]
European Society for Medical Oncology. Clinical practice guidelines - thyroid cancer. 2019 [internet publication].[Full Text]

Other Online Resources

US Department of Health and Human Services: potassium iodide

Referenced Articles

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