Benign and Malignant Thyroid Diseases

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Disease ◽  
Medullary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Cell Types ◽  
Follicular Cells ◽  
Toxic Nodular Goiter ◽  
Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

Benign and Malignant Thyroid Diseases

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Disease ◽  
Medullary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Cell Types ◽  
Follicular Cells ◽  
Toxic Nodular Goiter ◽  
Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

scholarly journals New therapeutic advances in the management of progressive thyroid cancer

2009 ◽  
Vol 16 (3) ◽  
pp. 715-731 ◽  
Author(s):  
Jennifer A Woyach ◽  
Manisha H Shah
Keyword(s):  
Thyroid Cancer ◽  
Targeted Therapy ◽  
Medullary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Standard Of Care ◽  
Anaplastic Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Cancers ◽  
Standard Of Care Treatment ◽  
Systemic Therapies

The spectrum of thyroid cancers ranges from one of the most indolent to one of the most aggressive solid tumors identified. Conventional therapies for thyroid cancers are based on the histologic type of thyroid cancers such as papillary or follicular thyroid cancer (differentiated thyroid cancer (DTC)), medullary thyroid cancer (MTC), or anaplastic thyroid cancer (ATC). While surgery is one of the key treatments for all such types of thyroid cancers, additional therapies vary. Effective targeted therapy for DTC is a decades-old practice with systemic therapies of thyroid stimulating hormone suppression and radioactive iodine therapy. However, for the iodine-refractory DTC, MTC, and ATC there is no effective systemic standard of care treatment. Recent advances in understanding pathogenesis of DTC and development of molecular targeted therapy have dramatically transformed the field of clinical research in thyroid cancer. Over the last five years, incredible progress has been made and phases I–III clinical trials have been conducted in various types of thyroid cancers with some remarkable results that has made an impact on lives of patients with thyroid cancer. Such history-making events have boosted enthusiasm and interest among researchers, clinicians, patients, and sponsors and we anticipate ongoing efforts to develop more effective and safe therapies for thyroid cancer.

scholarly journals Collision tumor of the thyroid – a challenge during the COVID-19 pandemic

2021 ◽  
Vol 8 (4) ◽  
pp. 64-71
Author(s):  
Mihaela Vlad ◽  
◽  
Ana Corlan ◽  
Melania Balas ◽  
◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Multinodular Goiter ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Collision Tumor ◽  
Left Lobe ◽  
Thyroid Microcarcinoma ◽  
Neoplastic Lesion ◽  
Cervical Swelling ◽  
The Right

Some of the patients with anaplastic thyroid carcinomas have a coexistent differentiated thyroid cancer, sustaining the hypothesis that this cancer may develop from more differentiated tumors. We describe a case with a collision tumor of the thyroid, defined as a neoplastic lesion composed of two distinct cell populations, with distinct borders. The patient presented during the COVID-19 pandemic with dysphonia, dyspnea, multinodular goiter and a painless, rapidly enlarging, left cervical swelling. She had been first time diagnosed with left nodular goiter in 2007, with an indication for surgery, which she declined. After partial excision of the left latero-cervical adenopathy, the pathological analysis showed massive lymph node metastasis from anaplastic thyroid cancer. A total thyroidectomy was done; the postoperative pathological exam identified a papillary thyroid microcarcinoma in the right lobe and an anaplastic thyroid cancer in the left lobe. Postoperatively, levothyroxine treatment was started and the patient was referred to radiotherapy. This case highlights the importance of urgent management of some cases with compressive multinodular goiter, even during the COVID-19 pandemic.

scholarly journals Classification, gradation, prognostic factors and risk factors for thyroid carcinoma

2003 ◽  
Vol 50 (3) ◽  
pp. 56-60
Author(s):  
Vladan Zivaljevic ◽  
Ivan Paunovic ◽  
Aleksandar Diklic ◽  
Ksenija Krgovic ◽  
Rastko Zivic ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factors ◽  
Thyroid Carcinoma ◽  
Multiple Endocrine Neoplasia ◽  
Endemic Goiter ◽  
Anaplastic Thyroid Cancer ◽  
External Radiation ◽  
Follicular Cells ◽  
Follicular Thyroid Cancer ◽  
Area Increase

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma?). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.

scholarly journals Graves’ Disease

2021 ◽  
Author(s):  
Paula Aragão Prazeres de Oliveira ◽  
Beatriz Nayara Muniz de Oliveira ◽  
Eduarda da Silva Souza Paulino ◽  
Fernanda Carolinne Marinho de Araujo ◽  
Paula Gabriele Tabosa Lyra
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Radioactive Iodine ◽  
Clinical Manifestations ◽  
Nodular Goiter ◽  
Graves Disease ◽  
Decompression Surgery ◽  
Excessive Sweating ◽  
Toxic Nodular Goiter ◽  
Diffuse Goiter

DG presents with three main presentations: hyperthyroidism with diffuse goiter, infiltrative ophthalmopathy and pre-tibial myxedema. Patients with Graves’ disease can rarely develop severe hyperthyroidism. The hyperthyroidism of Graves’ disease is characterized immunologically by the lymphocytic infiltration of the thyroid gland and by the activation of the immune system with elevation of the circulating T lymphocytes. In GD, goiter is characteristically diffuse. May have asymmetric or lobular character, with variable volume. The clinical manifestations of hyperthyroidism are due to the stimulatory effect of thyroid hormones on metabolism and tissues. Nervousness, eye complaints, insomnia, weight loss, tachycardia, palpitations, heat intolerance, damp and hot skin with excessive sweating, tremors, hyperdefecation and muscle weakness are the main characteristics. In the laboratory diagnosis, biochemical and hormonal exams will be done to assess thyroid hormones and the antithyroid antibodies. Additionally, imaging tests may be performed, such as radioactive iodine capture in 24 hours, ultrasonography, thyroid scintigraphy and fine needle aspiration. It is necessary to make the differential diagnosis of Graves’ disease for thyrotoxicosis, subacute lymphocytic thyroiditis and toxic nodular goiter. The treatment of DG aims to stop the production of thyroid hormones and inhibit the effect of thyroid hormones on the body. Hyperthyroidism caused by DG can be treated in the following ways: it may be the use of synthetic antithyroid medicines, thionamides, MMI being a long-term medicine, it allows a single daily dose, and adherence to treatment occurs, a disadvantage is that it cannot be used in pregnant women; beta-blockers, preferably used in the initial phase of DG with thionamides; radioactive iodine therapy (RAI), being the best cost–benefit and preventing DG recurrence; finally the total thyroidectomy, causing the withdrawal of the thyroid gland. Therefore, it should be discussed with the patient what is the best treatment for your case, with a view to the post and against each approach. If the patient develops Graves ophthalmopathy, in lighter cases the artificial tears should be used, and in more severe cases can be used as treatment, corticosteroids, orbital decompression surgery, prisms and orbital radiotherapy. In addition, the patient should keep their body healthy, doing exercise and healthy eating, following the guidance of their doctor.

scholarly journals Outcome of radioactive iodine therapy in Toxic Nodular Goiter in Pakistan

2018 ◽  
Vol 34 (5) ◽  
Author(s):  
Tauseef Ahmad ◽  
Adeel Khoja ◽  
Naveed Haroon Rashid ◽  
Muhammad Areeb Ashfaq
Keyword(s):  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Radioactive Iodine Therapy ◽  
Toxic Nodular Goiter

scholarly journals MON-446 Anaplastic Thyroid Cancer Presenting with Brain Metastasis: 17-Year Progression Free Survival

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kathryn Kay Howard ◽  
Morta Lapkus ◽  
Natalie Johnson ◽  
Sapna Nagar ◽  
Peter Czako
Keyword(s):  
Thyroid Cancer ◽  
Radioactive Iodine ◽  
Anaplastic Thyroid Cancer ◽  
Brain Lesions ◽  
Term Survival ◽  
Long Term Survival ◽  
Whole Brain Radiation ◽  
Iodine Treatment ◽  
Brain Radiation

Abstract Background: Anaplastic Thyroid Cancer is the most aggressive thyroid cancer with a median survival of just five months. Long term survival has been reported in locally aggressive cases, but has yet to be reported in metastatic disease. Case Information: A 34-year-old male presented with symptoms of dizziness, confusion, intermittent headaches, and erratic behavior for two weeks. CT of the head revealed a 1 cm ring enhancing lesion in the left parietal lobe with surrounding vasogenic edema. He was taken to the operating room for a left parietal craniotomy and a vascular, solid mass was removed. Initial pathology suggested papillary thyroid origin due to positive staining for thyroid transcription factor (TTF) and thyroglobulin (Tg). On exam, he had a palpable 3 cm mass in the right thyroid lobe with no associated adenopathy. He underwent thyroidectomy to optimize post-operative radioactive iodine treatment. Intraoperative frozen section revealed anaplastic thyroid cancer and final pathology revealed anaplastic carcinoma identical to the brain lesion. The tumor pathology showed extension through the thyroid capsule with lymphovascular invasion and one of two positive lymph nodes. Post-operatively, he underwent 15 cycles of whole brain radiation therapy for a total of 35 Gy. Two additional brain lesions were identified after thyroidectomy and a third was identified after whole brain radiation. He underwent stereotactic radiosurgery of these three lesions less than two months after thyroidectomy. The patient went on to receive modified mantle field irradiation (46 cycles, total 55.2 Gy) to the neck, thyroid bed, and the upper mediastinum. Additionally, he received chemotherapy with doxorubicin 6-8 weeks and temozolomide for 2 years. Thyroid uptake studies showed minimal residual iodine-avid disease and, in the setting of chemotherapy-induced cytopenias, radioactive iodine treatment was not administered. The patient has currently survived 17 years post-treatment. His persistent, but stable, brain lesions are being followed with serial imaging. He remains clinically and neurologically asymptomatic. Conclusions: This is the first case presenting with long-term survival in a patient with metastatic anaplastic thyroid carcinoma. A multidisciplinary course with early aggressive surgical removal, adjuvant treatment with chemotherapy and radiation, and long term imaging follow up may be an acceptable treatment plan for stable patients. References: Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012;22(11):1104-39.

scholarly journals Novel Therapeutics in Radioactive Iodine-Resistant Thyroid Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Tanner Fullmer ◽  
Maria E. Cabanillas ◽  
Mark Zafereo
Keyword(s):  
Thyroid Cancer ◽  
Radioactive Iodine ◽  
Kinase Inhibitors ◽  
Anaplastic Thyroid Cancer ◽  
Therapeutic Options ◽  
Novel Therapeutics ◽  
Iodine Treatment ◽  
Small Molecular Inhibitors ◽  
Related Mortality ◽  
Novel Therapeutic

Iodine-resistant cancers account for the vast majority of thyroid related mortality and, until recently, there were limited therapeutic options. However, over the last decade our understanding of the molecular foundation of thyroid function and carcinogenesis has driven the development of many novel therapeutics. These include FDA approved tyrosine kinase inhibitors and small molecular inhibitors of VEGFR, BRAF, MEK, NTRK and RET, which collectively have significantly changed the prognostic outlook for this patient population. Some therapeutics can re-sensitize de-differentiated cancers to iodine, allowing for radioactive iodine treatment and improved disease control. Remarkably, there is now an FDA approved treatment for BRAF-mutated patients with anaplastic thyroid cancer, previously considered invariably and rapidly fatal. The treatment landscape for iodine-resistant thyroid cancer is changing rapidly with many new targets, therapeutics, clinical trials, and approved treatments. We provide an up-to-date review of novel therapeutic options in the treatment of iodine-resistant thyroid cancer.

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