Thyroid cancer

Thyroid cancer

Overview
Thyroid neoplasm is a neoplasm or tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

 of the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

. It can be a benign tumor such as thyroid adenoma
Thyroid adenoma
-Types:Almost all thyroid adenomas are follicular adenomas. Follicular adenomas can be described as "cold", "warm" or "hot" depending on their level of function...

, or it can be a malignant neoplasm (thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

), such as papillary
Papillary thyroid cancer
Papillary thyroid cancer or papillary thyroid carcinoma is the most common type of thyroid cancer, representing 75% to 85% of all thyroid cancer cases. It occurs more frequently in women and presents in the 30-40 year age group...

, follicular
Follicular thyroid cancer
Follicular thyroid cancer accounts for 15% of thyroid cancer which occurs more commonly in women of over 50 years old. Thyroglobulin can be used as a tumor marker for well-differentiated follicular thyroid cancer.-Classification:...

, medullary
Medullary thyroid cancer
Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells , which produce the hormone calcitonin....

 or anaplastic thyroid cancer
Anaplastic thyroid cancer
Anaplastic thyroid cancer is a form of thyroid cancer which has a very poor prognosis due to its aggressive behavior and resistance to cancer treatments.-Presentation:...

. Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. The estimated number of new cases of thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

 in the United States in 2010 is 44670 compared to only 1690 deaths. Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.


The first step in diagnosing a thyroid neoplasm is a physical exam of the neck area.
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Encyclopedia
Thyroid neoplasm is a neoplasm or tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

 of the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

. It can be a benign tumor such as thyroid adenoma
Thyroid adenoma
-Types:Almost all thyroid adenomas are follicular adenomas. Follicular adenomas can be described as "cold", "warm" or "hot" depending on their level of function...

, or it can be a malignant neoplasm (thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

), such as papillary
Papillary thyroid cancer
Papillary thyroid cancer or papillary thyroid carcinoma is the most common type of thyroid cancer, representing 75% to 85% of all thyroid cancer cases. It occurs more frequently in women and presents in the 30-40 year age group...

, follicular
Follicular thyroid cancer
Follicular thyroid cancer accounts for 15% of thyroid cancer which occurs more commonly in women of over 50 years old. Thyroglobulin can be used as a tumor marker for well-differentiated follicular thyroid cancer.-Classification:...

, medullary
Medullary thyroid cancer
Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells , which produce the hormone calcitonin....

 or anaplastic thyroid cancer
Anaplastic thyroid cancer
Anaplastic thyroid cancer is a form of thyroid cancer which has a very poor prognosis due to its aggressive behavior and resistance to cancer treatments.-Presentation:...

. Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. The estimated number of new cases of thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

 in the United States in 2010 is 44670 compared to only 1690 deaths. Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

Diagnosis



The first step in diagnosing a thyroid neoplasm is a physical exam of the neck area. If any abnormalities exist, a doctor needs to be consulted. A family doctor may conduct blood tests, an ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

, and nuclear scan as steps to a diagnosis. The results from these tests are then read by an endocrinologist who will determine what problems the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

 has.
Hyperthyroidism
Hyperthyroidism
Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...

 and Hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...

 are two conditions that often arise from an abnormally functioning thyroid gland. These occur when the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

 is producing too much or too little thyroid hormone
Thyroid hormone
The thyroid hormones, thyroxine and triiodothyronine , are tyrosine-based hormones produced by the thyroid gland primarily responsible for regulation of metabolism. An important component in the synthesis of thyroid hormones is iodine. The major form of thyroid hormone in the blood is thyroxine ,...

 respectively.

Thyroid nodule
Thyroid nodule
Thyroid nodules are lumps which commonly arise within an otherwise normal thyroid gland. They indicate a thyroid neoplasm, but only a small percentage of these are thyroid cancers.-Presentation:...

s is a major presentation of thyroid neoplasms, and is diagnosed by ultrasound guided fine needle aspiration (USG/FNA) or frequently by thyroidectomy
Thyroidectomy
A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland...

 (surgical removal and subsequent histological examination).FNA is the most cost-effective and accurate method of obtaining a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 sample. As thyroid cancer can take up iodine
Iodine
Iodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....

, radioactive iodine is commonly used to treat thyroid carcinomas, followed by TSH
Thyroid-stimulating hormone
Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...

 suppression by high-dose thyroxine
Thyroxine
Thyroxine, or 3,5,3',5'-tetraiodothyronine , a form of thyroid hormones, is the major hormone secreted by the follicular cells of the thyroid gland.-Synthesis and regulation:...

 therapy.

Nodules
Nodule (medicine)
For use of the term nodule in dermatology, see Nodule In medicine, a nodule refers to a relatively hard, roughly spherical abnormal structure....

 are of particular concern when they are found in those under the age of 20. The presentation of benign nodules at this age is less likely, and thus the potential for malignancy is far greater.

Classification


Thyroid adenoma
Thyroid adenoma
-Types:Almost all thyroid adenomas are follicular adenomas. Follicular adenomas can be described as "cold", "warm" or "hot" depending on their level of function...

 is a benign neoplasm of the thyroid. Thyroid nodules are very common and around 80 percent of adults will have at least one by the time they reach 70 years of age. Approximately 90 to 95 percent of all nodules are found to be benign.

Thyroid cancers (malignant neoplasms) are mainly papillary
Papillary thyroid cancer
Papillary thyroid cancer or papillary thyroid carcinoma is the most common type of thyroid cancer, representing 75% to 85% of all thyroid cancer cases. It occurs more frequently in women and presents in the 30-40 year age group...

, follicular
Follicular thyroid cancer
Follicular thyroid cancer accounts for 15% of thyroid cancer which occurs more commonly in women of over 50 years old. Thyroglobulin can be used as a tumor marker for well-differentiated follicular thyroid cancer.-Classification:...

, medullary
Medullary thyroid cancer
Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells , which produce the hormone calcitonin....

 or anaplastic thyroid cancer
Anaplastic thyroid cancer
Anaplastic thyroid cancer is a form of thyroid cancer which has a very poor prognosis due to its aggressive behavior and resistance to cancer treatments.-Presentation:...

. Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. Nearly 80 percent of thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

 is papillary and about 15 percent is follicular; both types grow slowly and can be cured if caught early. Medullary thyroid cancer
Medullary thyroid cancer
Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells , which produce the hormone calcitonin....

 makes up about 3 percent of this cancer. It grows slowly and can be controlled if caught early. Anaplastic is the most deadly and makes up around 2 percent. This type grows quickly and is hard to control. The classification is determined by looking at the sample of cells under a microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...

 and by which type of thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

 cell is present.

Treatment


Treatment of a thyroid nodule
Thyroid nodule
Thyroid nodules are lumps which commonly arise within an otherwise normal thyroid gland. They indicate a thyroid neoplasm, but only a small percentage of these are thyroid cancers.-Presentation:...

 depends on many things including size of the nodule, age of the patient, the type of thyroid cancer
Thyroid cancer
Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm , such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected...

, and whether or not it has spread to other tissues in the body.
If the nodule is benign, patients may receive thyroxine therapy to suppress thyroid-stimulating hormone
Thyroid-stimulating hormone
Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...

 and should be reevaluated in 6 months. However, if the benign nodule is inhibiting the patient's normal functions of life; such as breathing, speaking, or swallowing, the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

 may need to be removed.

If the nodule is malignant or has indeterminate cytologic features, it may require surgery. A thyroidectomy
Thyroidectomy
A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland...

 is a medium risk surgery that can result complications if not performed correctly. Problems with the voice, nerve or muscular damage, or bleeding from a lacerated blood vessel are rare but serious complications that may occur. After removing the thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...

, the patient must be supplied with a replacement hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

 for the rest of their life. This is commonly a daily oral medication prescribed by their endocrinologist.

Radioactive Iodine-131
Iodine-131
Iodine-131 , also called radioiodine , is an important radioisotope of iodine. It has a radioactive decay half-life of about eight days. Its uses are mostly medical and pharmaceutical...

 is used in patients with papillary or follicular thyroid cancer for ablation of residual thyroid tissue after surgery and for the treatment of thyroid cancer. Patients with medullary, anaplastic, and most Hurthle cell cancers do not benefit from this therapy. External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis.

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