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Thyroid Carcinoma
Introduction
These tumours present as ‘goitre’ and can remain silent for decades without any discomfort. There are four main types – papillary, follicular, medullary and anaplastic thyroid cancers
Signs and Symptoms
Diagnostic criteria
• Thyroid mass,
• laryngeal nerve palsy,
• hoarseness,
• dyspnea,
• dysphagia
Investigation
Thyroid function tests (T3, T4, TSH), FBC, LFTs, Urea & creatinine, serum calcitonin, serum thyroglobulin levels
• Thyroid scan, CXR, isotope bone scan, CT scan of the neck, Fine needle aspiration cytology (FNAC) of a thyroid lesion
Treatment:
Surgery is the mainstay of treatment; total or near total thyroidectomy. Radiotherapy is indicated in all cases of anaplastic carcinoma
Treatment
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Pharmacological
- • Radioactive iodine ablation is indicated in all patients with well differentiated thyroid cancer after surgery
• Thyroid-stimulating hormone (TSH) suppression therapy (levothyroxine)
TSH suppression to < 0.1 mU/L is indicated in intermediate and high–risk disease. TSH maintenance at or slightly below the lower–normal limit (0.3–2 mU/L) may be considered for low-risk disease
In patients with persistent disease, the serum TSH should be maintained below 0.1mU=L indefinitely in the absence of specific contraindication
In patients who are clinically and biochemically free of disease but who presented with high risk disease, consideration should be given to maintaining TSH suppressive therapy to achieve serum TSH levels of 0.1– 0.5mU=L for 5–10 years.
In patients free of disease, especially those at low risk for recurrence, the serum TSH may be Kept within the low normal range (0.3–2mU=L).
In patients who have not undergone remnant ablation who are clinically free of disease and have undetectable suppressed serum Thyroglobulin(Tg) and normal neck ultrasound, the serum TSH may be allowed to rise to the low normal range (0.3–2mU=L).
Chemotherapy for anaplastic, recurrent or metastatic cancer
• Placliataxel IV 175mg/m2 day 1 plus Doxorubicin IV 60mg/m2 day1 every 3 weeks up to 6 cycles.
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Non-pharmacological
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Prevention
Updated on,
5 Novemba 2020 11:14:04
References
1.STG
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