Abstract
The thyroid gland, among other endocrine glands, has a particular place due to its pathologies, by far the most frequents. This chapter presents the most relevant features of anatomy and physiology of the thyroid gland; it describes the diagnosis algorithm: clinical exam, serologic tests, ultrasound, fine needle aspiration biopsy, and imagistic techniques. The nuclear imagistic diagnoses are didactic, briefly presented according to the radiotracer used, indications, procedures, and key points. A large clinical part of cases is presented, with examples of images and interpretation. The part dedicated to therapy consists of nuclear therapy strategies for benign thyroid diseases and for thyroid carcinoma. This part has also a very extensive clinical case presentation, covering a multitude of interest with high-quality images.
Madman with Goiter: Medieval Painting
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Ali SZ, Cibas ES (eds) (2010) The Bethesda System for Reporting Thyroid Cytolopahology: definition, criteria and explanatory notes. Springer, New York
AACE/AME/ETA (2010) Thyroid nodule guidelines. Endocr Pract 16(suppl 1):1–43
Alexander EK, Pearce EN, Brent GA et al (2017) 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during pregnancy and the postpartum. Thyroid. doi:10.1089/thy.2016.0457. [Epub ahead of print]
American Association of Clinical Endocrinologists. American College of Endocrinology (2002) AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract 7(3):202–220
Anderson GS, Fish S, Nakhoda K et al (2003) Comparison of I-123 and I-131 for wholebody imaging after stimulation by recombinant human thyrotropin: a preliminary report. Clin Nucl Med 28:93–96
ATA/AACE (2011) Hyperthyroidism management guidelines. Endocr Pract 17(3):1–65
Avram AM (2014) Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification. J Nucl Med 53(5):754–764
Azizi G, Keller J, Lewis M et al (2013) Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid 23(6):734–740
Belhocine T, Rachinsky I, Akincioglu C (2008) How useful is an integrated SPECT/CT in clinical setting and research: evaluation of a low radiation dose 4 slice system. Open Med Imaging J 2:80–108
Biondi B, Filetti S, Schlumberger M (2005) Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 1:32–40
Bongiovanni M, Cibas H, Faquin W (2010) The role of thyroid fine needle aspiration cytology and the Bethesda system for reporting thyroid cytopathology. Diagn Histopathol 17(3):95–105
Bojunga J, Herrmann E, Meyer G et al (2010) Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150
Braga M, Cavalcanti TC, Collaco LM et al (2001) Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules. J Clin Endocrinol Metab 86:4089–4091
Braverman LE, Utiger RD (2000) The thyroid. In: Werner SC, Ingbar SH (ed). 8th edn. Lippincott, Philadelphia
Brose MS et al (2014) Sorafenib in locally advanced or metastatic, radioactive iodine-refractory, differentiated thyroid cancer: a randomized, double-blind, phase 3 trial. Lancet 384(9940):319–328
Cabanillas ME, Waguespack SG, Bronstein Y et al (2010) Treatment with tyrosine kinase inhibitors for patients with differentiated thyroid cancer: the M. D. Anderson experience. J Clin Endocrinol Metab 95(6):2588–2595
Canchola AJ, Horn-Ross PL, Purdie DM (2006) Risk of second primary malignancies in women with papillary thyroid cancer. Am J Epidemiol 163:521–527
Carril JM, Quirce R, Serrano J et al (1997) Total-body scintigraphy with thallium-201 and iodine-131 in the follow-up of differentiated thyroid cancer. J Nucl Med 38:686–692
Ceccarelli C, Battisti P, Gasperi M et al (1999) Radiation dose to the testes after 131-I therapy for ablation of post-surgical thyroid remnants in patients with differentiated thyroid cancer. J Nucl Med 40:1716–1721
Chianelli M, Todino V, Graziano F et al (2009) Low dose (2.0 GBq; 54 mCi) radioiodine postsurgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low risk patients. Eur J Endocrinol 160:431–436
Clark OH, Duh QY (1990) Thyroid cancer. The thyroid gland. Raven Press, New York
Collins J, Rossi ED, Chandra A, Ali SZ (2015) Terminology and nomenclature schemes for reporting thyroid cytopathology: an overview. Semin Diagn Pathol 32(4):258–263
DeLellis RA, Lloyd RV, Heitz PU et al (2004) World Health Organization classification of tumours. Pathology and genetics of endocrine organs. IARC Press, Lyon, pp 49–135
DeVita VT, Hellman S, Rosenberg AS (2001) Cancer. Principles and practice of oncology, 6th edn. Lippincott, Philadelphia
Dunn JT (1994) When is a thyroid nodule a sporadic medullary carcinoma. J Clin Endocrinol Metab 78:824–825
Elisei R, Bottici V, Luchetti F et al (2004) Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 89:163–168
Francis GL, Waguespack SG, Bauer AJ et al (2015) American Thyroid Association Guidelines Task Force. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25(7):716–759
Franzius C, Dietlein M, Biermann M et al (2007) Procedure guideline for radioiodine therapy and 131-iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer. Nuklearmedizin 46:224–231
Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 237:794–800
Gaengler S, Andrianou XD, Piciu A et al (2017) Iodine status and thyroid nodules in females: a comparison of Cyprus and Romania. Public Health 143:37–43
Gerard SK, Cavalieri RR (2002) I-123 diagnostic thyroid tumour whole-body scanning with imaging at 6, 24, and 48 hours. Clin Nucl Med 27:1–8
Giovanella L, Campenni A, Treglia G et al (2016) Molecular imaging with (99m)Tc-MIBI and molecular testing for mutations in differentiating benign from malignant follicular neoplasm: a prospective comparison. Eur J Nucl Med Mol Imaging 43:1018–1026
Goldstein RE, Netterville JL, Burkey B et al (2002) Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules. Ann Surg 235:656–662
Guarino E, Tarantini B, Pilli T et al (2005) Presurgical serum thyroglobulin has no prognostic value in papillary thyroid cancer. Thyroid 15:1041–1045
British Thyroid Association and Royal College of Physicians (2007) Guidelines for the management of thyroid cancer in adults, 2nd edn. Publication Unit of the Royal College of Physicians. British Thyroid Association and Royal College of Physicians, London
British Thyroid Association and Royal College of Physicians (2014) Guidelines for the management of thyroid cancer in adults (3rd ed). Publication unit of the Royal College of Physicians. British Thyroid Association and Royal College of Physicians, London. Clin Endocrinol (Oxf) 81(suppl 1):1–122
Hackshaw A, Harmer C, Mallick U et al (2007) 131I activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J Clin Endocrinol Metab 92:28–38
Hay ID, Bergstralh EJ, Goellner JR et al (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058
Hay ID, Thompson GB, Grant CS et al (2002) Papillary thyroid carcinoma managed at the Mayo clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg (8):879–885
Haugen BR, Alexander EK, Bible KC et al (2016) American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133
Haugen BR, Sawka AM, Alexander EK et al (2017) The ATA guidelines on management of thyroid nodules and differentiated thyroid cancer task force review and recommendation on the proposed renaming of EFVPTC without invasion to NIFTP. Thyroid. doi:10.1089/thy.2016.0628. [Epub ahead of print]
Haugen BR (2017) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed? Cancer 123(3):372–381
Hegedus L (2001) Thyroid ultrasound. Endocrinol Metab Clin North Am 30:339–360
Ho AL, Grewal RK, Leboeuf R et al (2013) Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med 368:623–632
Hodgson NC, Button J, Solorzano CC (2004) Thyroid cancer: is the incidence still increasing? Ann Surg Oncol 11:1093–1097
Ito Y, Suzuki S, Ito K et al (2016) Tyrosine-kinase inhibitors to treat radioiodine-refracted, metastatic, or recurred and progressive differentiated thyroid carcinoma [Review]. Endocr J 63(7):597–602
Koizumi K, Tamaki N, Inoue T, Subcommittee on Survey of Nuclear Medicine Practice in Japan (2004) Nuclear medicine practice in Japan: a report of the 5th nationwide survey in 2002. Ann Nucl Med 18(1):73–78
Koh J, Moon HJ, Park JS et al (2016) Variability in interpretation of ultrasound elastography and gray-scale ultrasound in assessing thyroid nodules. Ultrasound Med Biol 42(1):51–59
Lee SG, Lee WK, Lee HS et al (2017) Practical performance of the 2015 American Thyroid Association Guidelines for predicting tumor recurrence in patients with papillary thyroid cancer in South Korea. Thyroid 27(2):174–181
Leger AF, Pellan M, Dagousset F et al (2005) A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of 131I and review of the literature: implications for sequential treatments. Br J Radiol 78:428–432
Luster M, Clarke SE, Dietlein M et al (2008) Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. doi:10.1007/s00259-008-0883-1
Machens A, Holzhausen HJ, Dralle H (2005) The prognostic value of primary tumour size in papillary and follicular thyroid carcinoma. Cancer 103:2269–2273
Mandel SJ, Mandel L (2003) Radioactive iodine and the salivary glands. Thyroid 13:265–271
Marqusee E, Benson CB, Frates MC et al (2000) Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 133:696–700
Mayr B, Brabant G, von zur Muhlen A (1999) Incidental detection of familial medullary thyroid carcinoma by calcitonin screening for nodular thyroid disease. Eur J Endocrinol 141:286–289
Mazzaferri EL, Jhiang SM (1994) Long term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 49:418–428
Mazzaferri EL, Robbins RJ, Spencer CA et al (2003) A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 88:1433–1441
Mitchell AL, Gandhi A, Scott-Coombes D, Perros P (2016) Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(S2):S150–S160
NCCN (2016) Clinical practice guidelines in oncology (NCCN Guidelines) Thyroid Carcinoma. Version 1.2016, 07/08/2016 © National Comprehensive Cancer Network, Inc. 2016
Nikiforov YE (2015) Thyroid cancer in 2015: molecular landscape of thyroid cancer continues to be deciphered. Nat Rev Endocrinol 12(2):67–68
Nikiforov YE, Seethala RR, Tallini G et al (2016) Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2(8):1023–1029
Pacini F, Burroni L, Ciuoli C et al (2004) Management of thyroid nodules: a clinicopathological, evidence based approach. Eur J Nucl Med Mol Imaging 31:1443–1449
Pacini F, Ladenson PW, Schlumberger M et al (2006a) Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized controlled study. J Clin Endocrinol Metab 91:926–932
Pacini F, Schlumberger M, Dralle H et al (2006b) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803
Pacini F, Castagna MG, Brilli L et al (2010) Thyroid cancer ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol 21(5):214–219
Pacini F, Brianzoni E, Durante C et al (2016) Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian Society of Endocrinology. J Endocrinol Invest 39(3):341–347
Piccardo A, Puntoni M, Treglia G et al (2016) Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol 174:693–703
Piciu D, Piciu A, Irimie A (2012) Thyroid cancer in children: a 20-year study at a Romanian oncology institute. Endocr J 59(6):489–496
Piciu D, Irimie A, Piciu A (2014) Investigation of thyroid carcinoma over 40 years, using the database of the Ion Chiricuta Institute of Oncology Cluj-Napoca. J BUON 19(2):524–529
Piciu D, Pestean C, Barbus E et al (2016) Second malignancies in patients with differentiated thyroid carcinoma treated with low and medium activities of radioactive I-131. Clujul Med 89(3):384–389
Pitoia F, Ward L, Wohllk N et al (2009) Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq Bras Endocrinol Metabol 53(7):884–887
Rare cancers list. http://www.rarecare.eu/rarecancers/rarecancers.asp. Accessed 30 Oct 2011
Robbins J (1992) Treatment of thyroid cancer in childhood. Proceedings of a workshop National Institutes of Health, Bethesda, 1992, vol 3–61, pp 109–167
Robbins RJ, Wan Q, Grewal RK et al (2006) Real-time prognosis for metastatic thyroid carcinoma based on FDG-PET scanning. J Clin Endocrinol Metab 91:498–505
Rubino C, de Vathaire F, Dottorini ME et al (2003) Second primary malignancies in thyroid cancer patients. Br J Cancer 89:1638–1644
Russ G, Royer B, Bigorgne C et al (2013) Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 168:649–655
Ross DS, Burch HB, Cooper DS et al (2016) American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26(10):1343–1421
Sassolas G, Hafdi-Nejjari Z, Remontet L et al (2009) Thyroid cancer: is the incidence rise abating? Eur J Endocrinol 160(1):71–79
Sawka AM, Lakra DC, Lea J et al (2008) A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf) 69:479–490
Schlumberger M, Pacini F (1999) Thyroid tumours. Nucleon, Paris
Schulmberger M, Pacini F, Tuttle RM (2016) Thyroid tumours, 4th edn. IME, Paris
Schlumberger M, De Vathaire F, Ceccarelli C et al (1996) Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients. J Nucl Med 37:606–612
Schlumberger M, Pacini F, Wiersinga WM et al (2004) Follow-up and management of differentiated thyroid carcinoma: European perspective in clinical practice. Eur J Endocrinol 151:539–548
Shah JP, Loree TR et al (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661
Sipple JR (1961) The association of pheocromocitoma with cancer of thyroid gland. Am J Med 31:163–166
Staging & Grading Thyroid Carcinoma (2010) AJCC cancer staging handbook, 7th edn. Springer, New York
Stokkel MPM, Handkiewicz Junak D, Lassmann M et al (2010) EANM procedure guidelines for therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 37:2218–2228. doi:10.1007/s00259-010-1536-8
Takami H, Ito Y, Okamoto T et al (2014) Revisiting the guidelines issued by the Japanese Society of Thyroid Surgeons and Japan Association of Endocrine Surgeons: a gradual move towards consensus between Japanese and western practice in the management of thyroid carcinoma. World J Surg 38(8):2002–2010
The American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2(16):3–34
The American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1195–1214
The American Thyroid Association Guidelines Task Force (2009) Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 19(6):565–612
The American Thyroid Association Taskforce on Radioiodine Safety (2011) Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: practice recommendations of the American Thyroid Association. Thyroid 21(4):1–12
Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): what changed and why? Thyroid 27(6):751–756. doi: 10.1089/thy.2017.0102. Epub 19 May 2017. PubMed PMID: 28463585; PubMed Central PMCID: PMC5467103
Tuttle RM, Leboeuf R, Robbins RJ, Qualey R, Pentlow K, Larson SM, Chan CY (2006) Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med 47(10):1587–1591
Tuttle RM, Brokhin M, Omry G et al (2008) Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med 49:764–770
Velzen van AJM, Chemaly CR (2005) A survey on radioisotope production capabilities, therapeutic radioisotope usage in Europe, expected trends in terms of research activities. European Commission report, pp 1–328
Verburg FA, Stokkel MP, Düren C et al (2010) No survival difference after successful (131) I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 37:276–283
Willegaignon J, Saptenza M, Ono C et al (2011) Outpatient radioiodine therapy for thyroid cancer. Clin Nucl Med 36(6):440–446
Yi KH (2016) The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinol Metab (Seoul) 31(3):373–378
Zimmermann D, Hay ID, Gough IR (1988) Papillary thyroid carcinoma in children and adults: long-term follow-up of 1039 patients conservatively treated at one institution during three decades. Surgery 104:1157–1166
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Piciu, D., Achimaș-Cadariu, P., Irimie, A., Piciu, A. (2017). The Thyroid Gland. In: Nuclear Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-56582-8_7
Download citation
DOI: https://doi.org/10.1007/978-3-319-56582-8_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-56581-1
Online ISBN: 978-3-319-56582-8
eBook Packages: MedicineMedicine (R0)