Thyroid Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Thyroid Gland
The thyroid is a gland at the base of the throat near the trachea . It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin.
The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:
- Control heart rate, body temperature, and how quickly food is changed into energy .
- Control the amount of calcium in the blood.
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What Kind Of Long
All follicular thyroid cancer patients are followed lifelong for their disease and hormone monitoring. Patients should receive an annual blood thyroglobulin level as well as high resolution ultrasound surveillance of the neck. Serum thyroglobulin are generally not useful as a screen for the initial diagnosis of thyroid cancer but is quite useful in follow up of well differentiated carcinoma . A high serum thyroglobulin level that had previously been low following total thyroidectomy especially if gradually increased with TSH stimulation is virtually indicative of recurrence. A value of greater than 10 ng/ml is often associated with structural recurrence even if an iodine scan is negative. Elevated thyroglobulin levels should be followed by diagnostic imaging efforts to define the potential local , regional or distant site analysis for structural abnormalities. Low unstimulated thyroglobulin levels in the 1-3 pg/ml may not be associated with identifiable structural disease.
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Differential Diagnosis Between Widely Invasive Ftc And Poorly Differentiated Thyroid Carcinoma
In the WHO book, PDTC has been recognized as a histopathological entity. The absence of clear diagnostic criteria for PDTC has been recently solved by Volante et al who described such criteria and advanced an algorithmic diagnostic approach for these tumors.
Despite the aforementioned developments in the diagnosis of PDTCs, it may be difficult to separate them from FTCs with a predominant trabecular/insular/solid growth pattern., , The same holds true regarding the separation of PDTCs from PTCs predominantly composed of trabecular, insular or solid areas whenever the nuclei of neoplastic cells superficially resemble the PTC nuclei., ,
In both instances , the foci of necrosis and high mitotic rate may be used in individual cases as signs suggestive of PDTC but should never be considered as absolute criteria., , The evaluation of the nuclear features is crucial whenever one faces the differential diagnosis with PTC if the nuclei in the poorly differentiated areas are of the PTC type, then we stick to the diagnosis of PTCs with trabecular or solid areas because the prognosis is much better than that of PDTCs.,
From a pragmatic standpoint, the separation of PDCs from FTCs only matters when one is dealing with a minimally invasive neoplasm, as widely invasive FTCs carry a prognosis that is similar to that of PDTCs and should be treated just as radically as them., ,
Deterrence And Patient Education
Although the prognosis of thyroid cancer has been reported to be good compared to other forms of cancer, the mention of the word “cancer” will still be a concern for most patients. For instance, most patients will still opt for surgical removal of the thyroid even if they have the non-invasive follicular thyroid cancer that can be followed due to its slow growth. Patients and their physicians need to work together to decide the best treatment option. Knowledge gained by patients will enable them to make better decisions about their health.
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Tests That May Be Done
Blood tests: Blood tests alone cant tell if a thyroid lump is cancer. But they can help show if the thyroid is working the way it should.
Ultrasound: For this test, a small wand is moved over the skin in front of your neck. It gives off sound waves and picks up the echoes as they bounce off the thyroid gland. The echoes are made into a picture on a computer screen. How a lump looks on ultrasound can sometimes help tell if its cancer, but ultrasound cant tell for sure.
Radioiodine scan: For this test, a low dose of radioactive iodine is swallowed or put into a vein. Over time, the iodine is absorbed by the thyroid gland. A special camera is then used to see the radioactivity. Nodules that have less iodine than the rest of the thyroid can sometimes be cancer.
CT or CAT scan: Its a special kind of x-ray that takes detailed pictures of the thyroid and can show if the cancer has spread.
MRI scan: This test uses radio waves and strong magnets instead of x-rays to take pictures. MRI scans can be used to look for cancer in the thyroid, or cancer that has spread.
PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a camera. If there is cancer, this sugar shows up as hot spots where the cancer is found. This test can be very useful if your thyroid cancer is one that doesnt take up radioactive iodine.
Thyroid biopsy
If the diagnosis is not clear after an FNA biopsy, you might need another kind of biopsy to get more cells to test.
What Is Thyroid Cancer
Thyroid cancer is a malignant tumour that starts in the cells of the thyroid. Malignant means that it can invade, or grow into, and destroy nearby tissue. It can also spread, or metastasize, to other parts of the body.
The thyroid is part of the endocrine system. It is a small gland in the front of the neck below the larynx and near the trachea . It has a right and left lobe, one on each side of the trachea. The lobes are joined by a thin piece of tissue called the isthmus.
The thyroid is mainly made up of follicular cells and C cells. Follicular cells make thyroid hormones. These hormones help break down food into energy. They also help control body functions such as body temperature, heart rate and breathing. C cells make the hormone calcitonin, which helps control the level of calcium in the blood.
Cells in the thyroid sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous, or benign, conditions such as hypothyroidism, hyperthyroidism, thyroid nodules, thyroiditis or goitre.
In some cases, changes to thyroid cells can cause cancer. The most common types of thyroid cancer are papillary carcinoma and follicular carcinoma. They are usually grouped together as differentiated thyroid cancer, which makes up more than 90% of all thyroid cancers.
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Preparation For Radioactive Iodine Treatment
Follicular thyroid cancer patients must be taken off of levothyroxine thyroid hormone for a minimum of four weeks, taken off of liothyrionine thyroid hormone for a minimum of two weeks, or receive a medication which is TSH . Additionally, follicular thyroid cancer patients must be on a low iodine diet for a minimum of four weeks to starve their body of iodine. Those patients which have undergone CAT scans with intravenous contrast must wait until their blood iodine levels have been adequately decreased . Note, a desire to treat with radioactive iodine should never prevent the use of necessary CAT scans for the evaluation of a follicular thyroid cancer patient.
The potential risks of RAI treatment include:
- Dry mouth and or eyes
- Narrowing of the drainage duct of the eye’s tears leading to excessive tearing down the cheek
- Swelling in your cheeks from inflammation or damage to the saliva producing glands
- Short term changes to taste and smell
- Lowered testosterone levels in males
- Change in periods in women
- Second tumors
Describe The Clinical Course Of Follicular Carcinoma
Follicular carcinoma usually presents as an asymptomatic nodule within the thyroid, but unlike papillary carcinoma, it may present as an isolated metastatic pulmonary or osseous focus without a palpable thyroid lesion. Rarely metastatic foci of follicular carcinoma retain hormonal synthetic capability and overproduce thyroid hormones, causing thyrotoxicosis. The tumor is nearly always encapsulated, and the degree of vascular or capsular invasiveness is indicative of malignant potential. Follicular carcinoma is usually unifocal . Death from follicular carcinoma occurs in 13% to 59% of patients followed for 20 years. Prognostic factors at the time of initial therapy that portend a poor outcome include age greater than 50 years, male sex , marked degree of vascular invasion, and distant metastases.
Kevin T. Brumund, Susan J. Mandel, in, 2021
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Follicular Thyroid Cancer Treatment
Follicular thyroid cancer treatment depends upon the stage of the cancer , the patient’s overall health, and the patients desires. This section discusses the typical treatment options for your follicular thyroid cancer. Treatment decision making is based upon three important factors:
- What is the optimal treatment for the follicular thyroid cancer
- What are the patient’s desires
- What are the capabilities and outcomes of the thyroid cancer team
How Is Pediatric Follicular Thyroid Cancer Diagnosed
The core evaluation of follicular thyroid carcinoma includes an initial comprehensive visit with a member of the Thyroid team as well as a blood draw to evaluate the function of the thyroid gland, an ultrasound of the thyroid and neck, and a fine needle aspiration biopsy of the thyroid mass.
- Ultrasound is a non-invasive test that uses sound waves to develop pictures of the thyroid gland.
- Fine needle aspiration involves a very small needle that is used to remove a sample of thyroid tissue that will then be analyzed by an expert pathologist who will assess for the presence of any cancer.
Based on the results of these and possible additional studies, a treatment plan will be recommended.
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Follicular Thyroid Cancer Surgery In Sites Other Than The Neck
Follicular thyroid cancer surgery is uncommonly proposed as a treatment approach when disease has spread to distant sites. Although surgery is not commonly proposed for distant spread of follicular thyroid cancer, consideration for surgery for distant disease is based upon the expert thyroid cancer team evaluation and considers the following issues:
- Where is the follicular thyroid cancer distant disease located?
- What are the risks and benefits of surgery?
- Are there other sites of distant spread?
- What follicular thyroid cancer treatments have already been used?
- What were the outcomes of other treatments for the follicular thyroid cancer?
- How fast is the follicular thyroid cancer growing?
- What are the patient’s treatment desires?
- What are the other treatment options?
- What is the follicular thyroid cancer pathologic type (what do the cells look like under the microscope?
- What are the follicular thyroid cancer genetic mutations found?
Extended Or Complicated Thyroidectomy
Follicular thyroid cancer may sometimes be more aggressive than ultrasound or CT imaging suggested prior to undergoing surgery. In these cases, an expert surgeon that recognizes those “more aggressive” intraoperative findings such as growth or extension of the cancer outside of the thyroid gland or invasion of the cancer into adjacent structures such as the nerve to the voice box , breathing tube , voice box, or esophagus-must adapt the surgery to adequately address the complete removal of the cancer. Unfortunately, occasional thyroid surgeons are commonly unprepared to perform the appropriate surgery and a subsequent surgery for persistent disease will be required.
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Identification Of Vascular Invasion Of Follicular Thyroid Neoplasms
In this study, we identified vascular invasion in 13 FTC cases and no FTA cases by H& E stained slides . IHC stain with CD31 and CD34 identified one more case in the FTC group, but no additional case in the FTA group. In the FTC group, one case was reported as “vascular invasion is equivocal”, but capsular invasion was present. Reexamination of the equivocal case confirmed vascular invasion on repeat H& E slides, which further was confirmed with IHC stains for CD31 and CD34. These results suggested that IHC stain with CD31 and CD34 could help identify more vascular invasion and identify vascular invasion more accurately, and that IHC staining with CD31 or CD34 should be done especially if vascular invasion was equivocal. We also found that CD34 stained many non-endothelial cells, which occasionally compromised evaluation of vascular invasion. In contrast, CD31 was more specific than CD34 for vascular endothelial cells, making evaluation of vascular invasion much clearer.
Table 1 IHC identification of vascular invasion of follicular thyroid neoplasms
The average number of vessels demonstrating vascular invasion was 0.88 ± 1.29 with a range from 0 to 5. The average diameter of involved vessels was 0.068 ± 0.027 mm.
Signs Of Thyroid Cancer Include A Swelling Or Lump In The Neck
Thyroid cancer may not cause early signs or symptoms. It is sometimes found during a routine physical exam. Signs or symptoms may occur as the tumor gets bigger. Other conditions may cause the same signs or symptoms. Check with your doctor if you have any of the following:
- A lump in the neck.
- Trouble breathing.
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Subtypes: Hrthle Cell Carcinomas And Insular Carcinoma
Follicular thyroid carcinomas with predominantly oxyphilic cells caused by metaplastic changes, with overabundance of large mitochondria, are known as Hürthle cell, oncocytic, or Askanazy cell carcinomas ,17 although they are distinct from Hürthle cell variants of papillary carcinoma.14 Hürthle cell adenomas are distinguished from carcinomas by noting the absence of capsular or vascular invasion in the same way as follicular adenomas are distinguished from carcinomas. HCFC is half as common as nonoxyphilic follicular carcinomas and is considered to be clinically more aggressive. This may be related to a higher rate of loss of radioiodine uptake in these tumors18 however, they seem to have the same prognosis as nonoxyphilic follicular cancers,19 particularly when matched for extent of local invasion at presentation.20
Jahangir Moini, … Raheleh Ahangari, in, 2020
Statistical Analysis And Synthesis Of The Results
Data were collected in a planned relational computer database including patients and tumor characteristics. All statistical analyses were carried out using the MedCalc® statistical software version 12.7.5 .
Data for tumor size and postoperative hospital stay were presented as the mean±standard deviation , as the median value and 95 % confidence interval . Data were compared for statistical analysis using the Fisher exact test to evaluate differences between qualitative variables and using the Students t-test to compare quantitative variables. The objective of statistical analysis was also to identify independent risk factors significantly related to the presence of a WI-FTC, to the recurrence of tumors, and to the disease-free survival at 10-year follow-up by means of stepwise logistic regression analysis. Differences were considered significant when p< 0.05. P values of the study have been reported as calculated by the statistical software.
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Surgical Treatment Of Ftc
Facing the difficulties of preoperative diagnosis, there is general consensus about how to surgically approach patients with follicular lesions. Basically, all patients diagnosed with solitary thyroid nodules with an indeterminate result in FNAC and/or the clinical suspicion of malignancy , should receive comprehensive information about the therapeutic options. This includes the well-known limitations, e.g., to intraoperatively distinguish minimally invasive, angioinvasive and widely invasive subtypes . Before surgery, patients should be made aware that the decision whether to perform lobectomy or thyroidectomy can be made intraoperatively by the surgeon. Depending on the histopathological result, in case of an initial lobectomy, secondary surgery may be necessary to perform a completion thyroidectomy.
When Should I Call My Doctor If I Suspect Hurthle Cell Carcinoma Or Any Thyroid Cancer
Contact your doctor if you have any symptoms of HCC or other thyroid cancer, especially:
- A painful lump in your throat
- Difficulty breathing, speaking, or swallowing
- Persistent fatigue
- Unexplained or unintentional weight loss
If you have been treated for HCC, make sure you follow any schedule of testing or appointments your healthcare provider recommends. You should also contact them if you have any difficulties or symptoms that worry you.
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Follicular Thyroid Cancer Long
You may have heard or experienced one of the following:
- You have the “good thyroid cancer”.
- You didn’t know you had follicular thyroid cancer until after your thyroid surgery.
- Your follicular thyroid cancer was not completely removed .
- Your follicular thyroid cancer has come back! .
- Your follicular thyroid cancer is located in other sites of your body other than your neck
- You had a follicular thyroid cancer and you underwent removal of half of your thyroid gland -called a thyroid lobectomy.
- You had a follicular thyroid cancer and underwent removal of all of your thyroid gland.
- Your blood marker for your follicular thyroid cancer is elevated.
For follicular thyroid cancer patients above 55 years of age, early recognition of the recurrence and the quality of further surgery and other follicular thyroid cancer treatments can effect your ability to be cured and survive your cancer. Therefore, early diagnosis of recurrent follicular thyroid cancer is very important.