Thyroid neoplasm

Last updated

Thyroid neoplasm
Thyroid lar ani.gif
Thyroid anatomy
Specialty Oncology   OOjs UI icon edit-ltr-progressive.svg

Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, [1] or it can be a malignant neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer. [2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. [2] [3] The estimated number of new cases of thyroid cancer in the United States in 2023 is 43,720 compared to only 2,120 deaths. [4] Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

Contents

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, 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 has. Hyperthyroidism and hypothyroidism are two conditions that often arise from an abnormally functioning thyroid gland. These occur when the thyroid is producing too much or too little thyroid hormone respectively. [4]

Thyroid nodules are a major presentation of thyroid neoplasms, and are diagnosed by ultrasound guided fine needle aspiration (USG/FNA) or frequently by thyroidectomy (surgical removal and subsequent histological examination). FNA is the most cost-effective and accurate method of obtaining a biopsy sample. [5] As thyroid cancer can take up iodine, radioactive iodine is commonly used to treat thyroid carcinomas, followed by TSH suppression by high-dose thyroxine therapy. [6]

Nodules 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. [7]

Classification

Thyroid neoplasm might be classified as benign or malignant.[ citation needed ]

Benign neoplasms

Thyroid adenoma 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. [4]

Malignant neoplasms

Thyroid cancers are mainly papillary, follicular, medullary or anaplastic thyroid cancer. [2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. [2] [3] Nearly 80 percent of thyroid cancer is papillary and about 15 percent is follicular; both types grow slowly and can be cured if caught early. Medullary thyroid cancer 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. [4] The classification is determined by looking at the sample of cells under a microscope and determining the type of thyroid cell that is present. Other thyroid malignancies include thyroid lymphoma, various types of thyroid sarcoma, smooth muscle tumors, teratoma, squamous cell thyroid carcinoma and other rare types of tumors. [8]

Treatment

Treatment of a thyroid nodule depends on many things including size of the nodule, age of the patient, the type of thyroid cancer, 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 and should be reevaluated in six months. [2] However, if the benign nodule is inhibiting the patient's normal functions of life; such as breathing, speaking, or swallowing, the thyroid may need to be removed.[ citation needed ] Sometimes only part of the thyroid is removed in an attempt to avoid causing hypothyroidism. There is still a risk of hypothyroidism though, as the remaining thyroid tissue may not be able to produce enough hormones in the long-run.[ citation needed ]

If the nodule is malignant or has indeterminate cytologic features, it may require surgery. [2] A thyroidectomy is a medium-risk surgery that can result in 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, the patient must be supplied with a replacement hormone for the rest of their life. This is commonly a daily oral medication prescribed by their endocrinologist. [10]

Radioactive iodine-131 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. [2] External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis. [2]

See also

Related Research Articles

<span class="mw-page-title-main">Thyroid</span> Endocrine gland in the neck; secretes hormones that influence metabolism

The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans, it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the isthmus (pl.: isthmi). The thyroid gland is a butterfly-shaped gland located in the neck below the Adam's apple. Microscopically, the functional unit of the thyroid gland is the spherical thyroid follicle, lined with follicular cells (thyrocytes), and occasional parafollicular cells that surround a lumen containing colloid. The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T3) and thyroxine (T4) – and a peptide hormone, calcitonin. The thyroid hormones influence the metabolic rate and protein synthesis and growth and development in children. Calcitonin plays a role in calcium homeostasis. Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is secreted from the anterior pituitary gland. TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus.

<span class="mw-page-title-main">Multiple endocrine neoplasia</span> Group of genetic conditions

Multiple endocrine neoplasia is a condition which encompasses several distinct syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. In some cases, the tumors are malignant, in others, benign. Benign or malignant tumors of nonendocrine tissues occur as components of some of these tumor syndromes.

<span class="mw-page-title-main">Carcinoma</span> Malignancy that develops from epithelial cells

Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis.

<span class="mw-page-title-main">Adenoma</span> Benign tumor of glandular origin and/or characteristics

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.

The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.

<span class="mw-page-title-main">Thyroid disease</span> Medical condition

Thyroid disease is a medical condition that affects the function of the thyroid gland. The thyroid gland is located at the front of the neck and produces thyroid hormones that travel through the blood to help regulate many other organs, meaning that it is an endocrine organ. These hormones normally act in the body to regulate energy use, infant development, and childhood development.

<span class="mw-page-title-main">Hürthle cell</span> Medical condition

A Hürthle cell is a cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as benign and malignant tumors. This version is a relatively rare form of differentiated thyroid cancer, accounting for only 3-10% of all differentiated thyroid cancers. Oncocytes in the thyroid are often called Hürthle cells. Although the terms oncocyte, oxyphilic cell, and Hürthle cell are used interchangeably, Hürthle cell is used only to indicate cells of thyroid follicular origin.

<span class="mw-page-title-main">Hürthle cell neoplasm</span> Medical condition

Hürthle cell neoplasm is a rare tumor of the thyroid, typically seen in women between the ages of 70 and 80 years old. When benign, it is called a Hürthle cell adenoma, and when malignant it is called a Hürthle cell carcinoma. Hürthle cell adenoma is characterized by a mass of benign Hürthle cells. Typically such a mass is removed because it is not easy to predict whether it will transform into the malignant counterpart of Hürthle cell carcinoma, which is a subtype of follicular thyroid cancer.

<span class="mw-page-title-main">Papillary thyroid cancer</span> Medical condition

Papillary thyroid cancer is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.

<span class="mw-page-title-main">Acinic cell carcinoma</span> Medical condition

Acinic cell carcinoma is a malignant tumor representing 2% of all salivary tumors. 90% of the time found in the parotid gland, 10% intraorally on buccal mucosa or palate. The disease presents as a slow growing mass, associated with pain or tenderness in 50% of the cases. Often appears pseudoencapsulated.

<span class="mw-page-title-main">Thyroid adenoma</span> Benign tumor of the thyroid gland

A thyroid adenoma is a benign tumor of the thyroid gland, that may be inactive or active as a toxic adenoma.

<span class="mw-page-title-main">Follicular thyroid cancer</span> Medical condition

Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumor marker for well-differentiated follicular thyroid cancer. Thyroid follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.

<span class="mw-page-title-main">Medullary thyroid cancer</span> Malignant thyroid neoplasm originating from C-cells

Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells, which produce the hormone calcitonin. Medullary tumors are the third most common of all thyroid cancers and together make up about 3% of all thyroid cancer cases. MTC was first characterized in 1959.

<span class="mw-page-title-main">Thyroid cancer</span> Medical condition

Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Cancer can also occur in the thyroid after spread from other locations, in which case it is not classified as thyroid cancer.

<span class="mw-page-title-main">Noninvasive follicular thyroid neoplasm with papillary-like nuclear features</span>

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor that was previously classified as an encapsulated follicular variant of papillary thyroid carcinoma, necessitating a new classification as it was recognized that encapsulated tumors without invasion have an indolent behavior, and may be over-treated if classified as a type of cancer.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

Dr. Yuri Nikiforov is an American scientist who revolutionized the understanding of thyroid cancer, most recently winning a two-year battle in which the World Health Organization agreed in 2017 to reclassify non-invasive thyroid tumors to non-cancerogenic liaisons. Those tumors typically have some, but not all, characteristics of cancer. The WHO has agreed to change the term for the tumors from Encapsulated Follicular Variant of Papillary Thyroid Carcinoma to Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features, or NIFTP. About 45,000 people a year are diagnosed with NIFTP in the world. The decision led to a change in the protocol of medical treatment, which no longer required removal of the whole thyroid gland from such patients as well as ended the use of radioactive iodine, extending their life expectancy and quality of life. The patients still undergo surgery, in which their thyroid tumors are removed, typically with half, but not all, of the thyroid gland.

References

  1. ↑ Mitchell RS, Kumar V, Abbas AK, Fausto N (2007). "Chapter 20: The Endocrine System". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN   978-1-4160-2973-1.
  2. 1 2 3 4 5 6 7 8 Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
  3. 1 2 Al-Zaher N, Al-Salam S, El Teraifi H (2008). "Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital". Hematology/Oncology and Stem Cell Therapy. 1 (1): 14–21. doi: 10.1016/s1658-3876(08)50055-0 . PMID   20063523.
  4. 1 2 3 4 "Cancer of the Thyroid - Cancer Stat Facts". The Surveillance, Epidemiology, and End Results (SEER). U.S. National Cancer Institute.
  5. ↑ Schmitt FC (June 2010). "Thyroid cytology: is FNA still the best diagnostic approach?". International Journal of Surgical Pathology. 18 (3 Suppl): 201S–204S. doi:10.1177/1066896910370884. PMID   20484291. S2CID   937920.
  6. ↑ Grani G, Ramundo V, Verrienti A, Sponziello M, Durante C (2019-10). "Thyroid hormone therapy in differentiated thyroid cancer". Endocrine. 66 (1): 43–50. doi:10.1007/s12020-019-02051-3. ISSN   1355-008X.{{cite journal}}: Check date values in: |date= (help)
  7. ↑ Grani G, Sponziello M, Filetti S, Durante C (2024-08-16). "Thyroid nodules: diagnosis and management". Nature Reviews Endocrinology. doi:10.1038/s41574-024-01025-4. ISSN   1759-5029.
  8. ↑ DeLellis RA, Lloyd RV, Heitz PU, Eng C, eds. (2004). Pathology and Genetics of Tumours of Endocrine Organs. World Health Organization Classification of Tumours. Vol. 8 (3rd ed.). Lyon, France: IARC Press. pp. 94–123. ISBN   978-92-832-2416-7.
  9. 1 2 3 4 5 6 7 8 9 10 11 Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M (September 2020). "Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers". Endocrine Pathology. 31 (3): 197–217. doi:10.1007/s12022-020-09638-x. PMC   7395918 . PMID   32632840.
    "This article is licensed under a Creative Commons Attribution 4.0 International License"
  10. ↑ Hannoush ZC, Weiss RE (January 2016). "Thyroid Hormone Replacement in Patients Following Thyroidectomy for Thyroid Cancer". Rambam Maimonides Medical Journal. 7 (1): e0002. doi:10.5041/RMMJ.10229. PMC   4737508 . PMID   26886951.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.