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Thyroid Cancer

Thyroid carcinoma is common in all age groups, and it is especially in patients who have received any radiation therapy to the face, neck, or upper chest. It is

Table 26B8. Some characteristics of thyroid cancer.

Papillary carcinoma is the most common and least aggressive thyroid malignancy. Pure papillary or mixed papillary-follicular carcinoma represents about 70% of all thyroid cancers. Follicular carcinoma represents about 15% of thyroid malignancies but is

Clinical Findings

A. Symptoms and Signs: The principal sign of thyroid carcinoma is a palpable, firm and nontender nodule in the thyroid area. Anterior cervical lymph nodes may be


Surgical removal is the treatment of choice for thyroid carcinomas. Highly skilled surgeons can perform near-total thyroidectomies with a less than 1% rate of serious complications (hypoparathyroidism or recurrent laryngeal nerve damage). Other series have

About 2B4 months after surgery, a whole-body 131I scan is performed: Iodide uptake is enhanced by stopping thyroxine for 6 weeks prior to the scan, thereby causing hypothyroidism; TSH then rises and stimulates iodide uptake. Iodine-containing foods and contrast media are avoided. Patients with "normal thyroid" remnants should receive 30B50 mCi of 131I if their cancer was 1.5 cm or more in diameter. Patients with extrathyroidal uptake from metastatic disease are given larger doses of 100B150 mCi in the hospital. Another whole-body scan several days after 131I treatment will sometimes detect metastases not visible on pretreatment scans.

False-positive 131I scans are common with normal residual thyroid tissue and have been reported with Zenker's diverticulum, ovary, pleuropericardial cyst, gastric pull-up, and 131I-contaminated bodily secretions. False-negative 131I scans are common in early

Patients with differentiated thyroid carcinoma are followed clinically with neck palpation, physical examination, and chest x-ray and observed for thyrotoxicosis that might indicate functioning metastases. About 6B12 months after their postoperative scan, patients usually receive another 131I whole