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Papillary Thyroid Carcinoma

  • Yasemin Giles Şenyürek
  • İsmail Cem Sormaz
Chapter

Abstract

Although most thyroid nodules are a result of a benign disease process (>90%), the possibility of thyroid cancer is always a consideration. Ultrasonography can help for differential diagnosis of thyroid nodules. Fine needle aspiration biopsy is the traditional diagnostic test to determine malignancy in thyroid nodules. We present a 58-year-old female patient with low-risk papillary thyroid carcinoma (PTC) who was treated by total thyroidectomy. Although the recent ATA guideline recommends that the extent of initial surgery can be a total or near-total thyroidectomy or lobectomy in low-risk unilateral PTC >1 cm and <4 cm, the extent of thyroidectomy in such patients should be decided according to the judgment of the treatment team and postoperative histopathological findings. In low-risk PTC patients, a suppressed or stimulated Tg <1 ng/mL by 3–4 weeks postoperatively and no evidence of disease by imaging further confirm classification of these patients as being at low risk. RAI (radioactive iodine) remnant ablation is not routinely recommended after thyroidectomy for ATA low-risk PTC patients.

Keywords

Papillary thyroid carcinoma Thyroidectomy Ultrasonography Fine needle aspiration biopsy 

References

  1. 1.
    Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin N Am. 2007;36:707–35.  https://doi.org/10.1016/j.ecl.2007.04.009.CrossRefGoogle Scholar
  2. 2.
    Jankovic B, Le KT, Hershman JM. Clinical Review: Hashimoto’s thyroiditis and papillary thyroid carcinoma: is there a correlation? J Clin Endocrinol Metab. 2009;98:474–82.  https://doi.org/10.1210/jc.2012-2978.CrossRefGoogle Scholar
  3. 3.
    Lee JH, Kim Y, Choi JW, Kim YS. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol. 2013;168:343–9.  https://doi.org/10.1530/EJE-12-0903.CrossRefPubMedGoogle Scholar
  4. 4.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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. 2016;26:1–133.  https://doi.org/10.1089/thy.2015.0020.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13:391–7.  https://doi.org/10.1016/j.autrev.2014.01.007.CrossRefPubMedGoogle Scholar
  6. 6.
    Morris LF, Ragavendra N, Yeh MW. Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg. 2008;32:1253–63.  https://doi.org/10.1007/s00268-008-9494-z.CrossRefPubMedGoogle Scholar
  7. 7.
    Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9.  https://doi.org/10.1148/radiol.11110206.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178:687–91.  https://doi.org/10.2214/ajr.178.3.1780687.CrossRefPubMedGoogle Scholar
  9. 9.
    Kuma K, Matsuzuka F, Kobayashi A, Hirai K, Morita S, Miyauchi A, et al. Outcome of long standing solitary thyroid nodules. World J Surg. 1992;16:583–8.CrossRefGoogle Scholar
  10. 10.
    Nakamura H, Hirokawa M, Ota H, Kihara M, Miya A, Miyauchi A. Is an increase in thyroid nodule volume a risk factor for malignancy? Thyroid. 2015;25:804–11.  https://doi.org/10.1089/thy.2014.0567.CrossRefPubMedGoogle Scholar
  11. 11.
    Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19:1159–65.  https://doi.org/10.1089/thy.2009.0274.CrossRefPubMedGoogle Scholar
  12. 12.
    Kini SR, Miller JM, Hamburger JI. Problems in the cytologic diagnosis of the “cold” thyroid nodule in patients with lymphocytic thyroiditis. Acta Cytol. 1981;25:506–12.PubMedGoogle Scholar
  13. 13.
    MacDonald L, Yazdi HM. Fine needle aspiration biopsy of Hashimoto’s thyroiditis. Sources of diagnostic error. Acta Cytol. 1999;43:400–6.CrossRefGoogle Scholar
  14. 14.
    Brancato D, Citarrella R, Richiusa P, Amato MC, Vetro C, Galluzzo CG. Neck lymph nodes in chronic autoimmune thyroiditis: the sonographic pattern. Thyroid. 2013;3:173–7.  https://doi.org/10.1089/thy.2012.0375.CrossRefGoogle Scholar
  15. 15.
    Raja Lakshmi C, Sudhakara Rao M, Ravikiran A, Sathish S, Bhavana SM. Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes. ISRN Otolaryngol. 2014;2014:238740.  https://doi.org/10.1155/2014/238740.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.  https://doi.org/10.1089/thy.2009.0110.CrossRefPubMedGoogle Scholar
  17. 17.
    Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375–84.  https://doi.org/10.1097/SLA.0b013e31814697d9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260:601–5.  https://doi.org/10.1097/SLA.0000000000000925.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Miccoli P, Bakkar S. Surgical management of papillary thyroid carcinoma: an overview. Updat Surg. 2017;69(2):145–50.  https://doi.org/10.1007/s13304-017-0449-5. [Epub ahead of print].CrossRefGoogle Scholar
  20. 20.
    Robbins J, Merino MJ, Boice JD Jr, Ron E, Ain KB, Alexander HR, et al. Thyroid cancer: a lethal endocrine neoplasm. Ann Intern Med. 1991;115:133–47.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Yasemin Giles Şenyürek
    • 1
  • İsmail Cem Sormaz
    • 1
  1. 1.Division of Endocrine SurgeryIstanbul University, Istanbul Medical FacultyIstanbulTurkey

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