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  • • History of radiation to the neck in some patients

    • Painless or enlarging nodule, dysphagia, or hoarseness

    • Firm or hard, fixed thyroid nodule; cervical lymphadenopathy

    • Normal thyroid function; nodule stippled with calcium (x-ray), solid (US), cold (radioiodine scan), positive or suspicious cytologic studies

    • Family history of thyroid cancer

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Epidemiology

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  • • Usually occurs in young adults

    • 80-85% of all thyroid cancers

    • 80% of children and 20% of adults present with clinically positive lymph node metastases

    • Psammoma bodies are seen on pathologic analysis in 60% of cases

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Symptoms and Signs

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  • • Solitary thyroid nodule

    • Enlarged or hard cervical lymph nodes

    • Pain in the thyroid or paralaryngeal neck

    • Hoarseness

    • Dyspnea

    • Stridor

    • Dysphagia

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Laboratory Findings

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  • • Normal thyroid-stimulating hormone (TSH) level

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Imaging Findings

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  • US: Solid or cystic nodule

    Radioiodine scan: Nonfunctioning (cold)

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  • • Grows slowly, and metastasizes through lymph nodes

    • Rate of growth may be stimulated by TSH

    • Often multifocal or bilobar

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Rule Out

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  • • Concurrent hyperparathyroidism (so that it can be treated at the same operation if necessary)

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  • • Complete history and physical, with attention to risk factors, family history, palpable characteristics of the nodule or lymphadenopathy

    • Serum TSH and calcium levels

    • Cervical ultrasound to assess the thyroid glad and cervical adenopathy

    • Fine-needle aspiration biopsy

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  • • Treatment starts with operative removal

    • External beam radiation may palliate nonresectable metastases that are resistant to radioiodine

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Surgery

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Indications

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  • • All papillary thyroid cancers should be excised

    • Total thyroidectomy for most patients; thyroid lobectomy adequate for some

    • Bulky or palpable nodal recurrences

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Medications

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  • • Suppressive doses of thyroid hormone after thyroid ablation or thyroidectomy

    • Radioactive iodine therapy for remnant, recurrent, or metastatic disease

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Treatment Monitoring

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  • • Semiannual or yearly serum thyroglobulin, thyroglobulin antibodies, and whole body radioiodine scan

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Complications

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  • • Neck hematoma

    • Superior laryngeal nerve injury

    • Recurrent laryngeal nerve injury

    • Transient or permanent hypoparathyroidism

    • Wound infection

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Prognosis

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  • • Very good even in the presence of metastases

    • 10-year survival rate after operation for papillary cancer is over 80%

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References

Cooper DS et al: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109.  [PubMed: 16420177]

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Practice Guidelines

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