Tuesday, March 9, 2010

Malignant tumor of thyroid gland

Malignant tumor of thyroid gland - Chronic

Definition  

A malignant tumor of the thyroid gland that ranges from an indolent and localized carcinoma of the thyroid to fulminant and lethal disease


 

Detection of residual, recurrent, or metastatic thyroid carcinoma  

* Thyroglobulin measurement: Serum thyroglobulin levels more than 2 mcg/L may indicate residual or recurrent thyroid cancer .


 

Medical History  

* Multinodular goiter

* Past medical history of Hashimoto thyroiditis

* Cancer

* Past exposure to ionizing radiation

* Dietary iodine deficiency

* Family history of Malignant tumor of thyroid gland


 

Findings  

* Thyroid nodule

* Localized enlarged lymph nodes

* Dysphagia - Chronic

* Difficulty speaking

* Vocal cord palsy


 

Tests  


 

Evaluation of patients with a palpable thyroid nodule, multinodular goiter, adenopathy suggestive of a malignant lesion, or high-risk patients  

* US scan of thyroid: Ultrasound is the most sensitive test available to detect thyroid nodules, accurately measure lesions, identify their structure, and note diffuse changes within the gland .


 

Evaluation of thyroid nodules in patients with suspected thyroid cancer  

* Fine needle biopsy of thyroid: Fine-needle aspiration results are reported as either benign, positive for thyroid carcinoma, indeterminate results, or nondiagnostic (inadequate specimen) .


 

Suspected or known hypothyroidism  

* Thyroid stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4) . Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.


 

Suspected hyperthyroidism  

* Thyroid stimulating hormone measurement: Overt hyperthyroidism is defined as a serum TSH less than 0.1 milliunits/L (mU/L) in the presence of an elevated serum free thyroxine (FT4), thyroxine (T4), or serum free triiodothyronine (FT3). Subclinical hyperthyroidism is defined as a TSH below the statistically defined lower limit of the reference range in the presence of a normal FT4 and FT3.


 

Suspected hyperthyroidism in patients with atrial fibrillation  

* Thyroid stimulating hormone measurement: A TSH level ?0.1 milliunits/L (mU/L) is associated with an increased risk of atrial fibrillation .


 

Differential Diagnosis  

* Papillary thyroid carcinoma

* Follicular thyroid carcinoma

* Medullary thyroid carcinoma

* Anaplastic thyroid carcinoma

* Multinodular goiter

* Hashimoto thyroiditis - Chronic

* Cyst of thyroid

* Thyroid follicular adenoma

* Subacute thyroiditis

* Graves' disease


 

Treatment  


 

Drug Therapy  


 

Thyroid stimulating hormone suppression in patients with differentiated thyroid cancer  


 

LEVOTHYROXINE SODIUM  

Adults: Doses higher than 2 mcg/kg/day orally are generally necessary to achieve TSH suppression below 0.1 mU/L


 

Hypothyroidism following thyroidectomy or radioiodine ablation therapy  


 

LEVOTHYROXINE SODIUM  

Adults: 1.7 mcg/kg/day orally in a single daily dose (usual maintenance dose 100 mcg to 200 mcg/day)


 

Follow-up of patients with well-differentiated thyroid cancer as an adjunctive diagnostic tool for serum thyroglobulin testing, radioiodine imaging, or both  


 

THYROTROPIN ALFA  

Adults: 0.9 mg IM every 24 hours for 2 doses, or every 72 hours for 3 doses

Pediatrics (16 years and older): 0.9 mg IM every 24 hours for 2 doses, or every 72 hours for 3 doses


 

Procedural Therapy  


 

Thyroid cancer  

* Thyroidectomy: Total thyroidectomy is the preferred initial surgical procedure for most patients with well-differentiated thyroid cancer .


 

Patients with papillary or follicular thyroid cancer who have undergone thyroidectomy  

* Radionuclide ablation of thyroid gland: Radioiodine ablation therapy following thyroidectomy for follicular-derived thyroid cancer may eliminate microscopic residual or metastatic thyroid cancer cells .

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