The Thyroid Gland

  • Doina PiciuEmail author


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, 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 cases presentation, covering a multitude of interesting with high quality images.


Single Photon Emission Compute Tomography Thyroid Cancer Thyroid Gland Thyroid Nodule Thyroid Stimulate Hormone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ali SZ, Cibas ES (eds). (2010) The Bethesda System for Reporting Thyroid Cytolopahology: definition, criteria and explanatory notes. Springer, New YorkGoogle Scholar
  2. AACE/AME/ETA (2010) Thyroid nodule guidelines. Endocr Pract 16(Suppl 1):1–43Google Scholar
  3. 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):202–220Google Scholar
  4. 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 28:93–96PubMedGoogle Scholar
  5. ATA/AACE (2011) Hyperthyroidism management guidelines. Endocr Pract 17(3):1–65Google Scholar
  6. Biondi B, Filetti S, Schlumberger M (2005) Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 1:32–40PubMedCrossRefGoogle Scholar
  7. Bongiovanni M, Cibas H, Faquin W (2010) The role of thyroid fine needle aspiration cytology and the Bethesda system for reporting thyroid cytopathology. Diagnostic Histopathology 17(3):95–105Google Scholar
  8. 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 86:4089–4091PubMedCrossRefGoogle Scholar
  9. Braverman LE, Utiger RD (2000) The thyroid. In: Werner SC and Ingbar SH (ed). 8th edn. Lippincott, PhiladelphiaGoogle Scholar
  10. Canchola AJ, Horn-Ross PL, Purdie DM (2006) Risk of second primary malignancies in women with papillary thyroid cancer. Am J Epidemiol 163:521–527PubMedCrossRefGoogle Scholar
  11. 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 38:686–692PubMedGoogle Scholar
  12. 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 40:1716–1721PubMedGoogle Scholar
  13. 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 160:431–436PubMedCrossRefGoogle Scholar
  14. Clark OH, Duh QY (1990) Thyroid cancer. The thyroid gland. Raven Press, New YorkGoogle Scholar
  15. 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 49–135Google Scholar
  16. DeVita VT, Hellman S, Rosenberg AS (2001) Cancer. Principles and practice of oncology, 6th edn. Lippincott, PhiladelphiaGoogle Scholar
  17. Dunn JT (1994) When is a thyroid nodule a sporadic medullary carcinoma. J Clin Endocrinol Metab 78:824–825PubMedCrossRefGoogle Scholar
  18. 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 89:163–168PubMedCrossRefGoogle Scholar
  19. 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 46:224–231PubMedGoogle Scholar
  20. 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 237:794–800PubMedCrossRefGoogle Scholar
  21. Gerard SK, Cavalieri RR (2002) I-123 diagnostic thyroid tumour whole-body scanning with imaging at 6, 24, and 48 hours. Clin Nucl Med 27:1–8PubMedCrossRefGoogle Scholar
  22. 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 235:656–662PubMedCrossRefGoogle Scholar
  23. Guarino E, Tarantini B, Pilli T et al (2005) Presurgical serum thyroglobulin has no prognostic value in papillary thyroid cancer. Thyroid 15:1041–1045PubMedCrossRefGoogle Scholar
  24. Guidelines for the management of thyroid cancer in adults (2007) 2nd Ed. Publication unit of the Royal College of Physicians. British Thyroid Association and Royal College of Physicians, LondonGoogle Scholar
  25. 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 92:28–38PubMedCrossRefGoogle Scholar
  26. 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 114:1050–1058PubMedGoogle Scholar
  27. 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 8:879–885CrossRefGoogle Scholar
  28. Hegedus L (2001) Thyroid ultrasound. Endocrinol Metab Clin North Am 30:339–360PubMedCrossRefGoogle Scholar
  29. Hodgson NC, Button J, Solorzano CC (2004) Thyroid cancer: is the incidence still increasing? Ann Surg Oncol 11:1093–1097PubMedCrossRefGoogle Scholar
  30. Koizumi K, Tamaki N, Inoue T and 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):73–78CrossRefGoogle Scholar
  31. 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 78:428–432PubMedCrossRefGoogle Scholar
  32. 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
  33. Machens A, Holzhausen HJ, Dralle H (2005) The prognostic value of primary tumour size in papillary and follicular thyroid carcinoma. Cancer 103:2269–2273PubMedCrossRefGoogle Scholar
  34. Mandel SJ, Mandel L (2003) Radioactive iodine and the salivary glands. Thyroid 13:265–271PubMedCrossRefGoogle Scholar
  35. Marqusee E, Benson CB, Frates MC et al (2000) Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 133:696–700PubMedGoogle Scholar
  36. 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 141:286–289PubMedCrossRefGoogle Scholar
  37. Mazzaferri EL, Jhiang SM (1994) Long term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 49:418–428CrossRefGoogle Scholar
  38. 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 88:1433–1441PubMedCrossRefGoogle Scholar
  39. NCCN (2012) Clinical practice guidelines in oncology (NCCN Guidelines) Thyroid Carcinoma. Version 2.2012, 12/19/11 © National Comprehensive Network, Inc 2011.Google Scholar
  40. Pacini F, Castagna MG, Brilli L et al (2010) Thyroid cancer ESMO clinical practice guideline for diagnosis, treatment and follow-up. Annals of oncology 21(5):214–219PubMedCrossRefGoogle Scholar
  41. Pacini F, Burroni L, Ciuoli C et al (2004) Management of thyroid nodules: a clinicopathological, evidence based approach. Eur J Nucl Med Mol Imaging 31:1443–1449PubMedCrossRefGoogle Scholar
  42. 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 91:926–932PubMedCrossRefGoogle Scholar
  43. 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 154:787–803PubMedCrossRefGoogle Scholar
  44. Rare cancers list.; Accessed 30 Oct 2011
  45. Robbins J (1992) Treatment of thyroid cancer in childhood. Proceedings of a workshop National Institutes of Health, Bethesda, 1992, 3–61:109–67Google Scholar
  46. 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 91:498–505PubMedCrossRefGoogle Scholar
  47. Rubino C, de Vathaire F, Dottorini ME et al (2003) Second primary malignancies in thyroid cancer patients. Br J Cancer 89:1638–1644PubMedCrossRefGoogle Scholar
  48. Sassolas G, Hafdi-Nejjari Z, Remontet L et al (2009) Thyroid cancer: is the incidence rise abating? Eur J Endocrinol 160(1):71–79PubMedCrossRefGoogle Scholar
  49. Schlumberger M, Pacini F (1999) Thyroid tumours. Nucleon, ParisGoogle Scholar
  50. 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 37:606–612PubMedGoogle Scholar
  51. 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 151:539–548PubMedCrossRefGoogle Scholar
  52. Shah JP, Loree TR et al (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661PubMedCrossRefGoogle Scholar
  53. Sipple JR (1961) The association of pheocromocitoma with cancer of thyroid gland. Am J Med 31:163–166CrossRefGoogle Scholar
  54. Staging & Grading Thyroid Carcinoma (2010) AJCC cancer staging handbook, 7th edn. Springer, New YorkGoogle Scholar
  55. 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 PubMedCrossRefGoogle Scholar
  56. The American Thyroid Association (f) 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 19:1195–1214Google Scholar
  57. The American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2(16):3–34Google Scholar
  58. 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):1–12Google Scholar
  59. Tuttle RM, Leboeuf R, Robbins RJ, Qualey R, Pentlow K, Larson SM and 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):1587–1591PubMedCrossRefGoogle Scholar
  60. 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 49:764–770PubMedCrossRefGoogle Scholar
  61. 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 1–328Google Scholar
  62. 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 37:276–283PubMedCrossRefGoogle Scholar
  63. Willegaignon J, Saptenza M, Ono C et al (2011) Outpatient radioiodine therapy for thyroid cancer. Clinical Nucl Medicine 36(6):440–446PubMedCrossRefGoogle Scholar
  64. 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 104:1157–1166Google Scholar

Copyright information

© Springer-Verlag GmbH Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Nuclear Medicine and Endocrine TumorsInstitute of Oncology Prof. Dr. Ion ChiricuţăCluj-NapocaRomania

Personalised recommendations