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6: Thyroid nodules and thyroid cancer

Med J Aust 2004; 180 (5): 242-247.

Summary

  • Thyroid nodules are common clinically (prevalence, about 5%) and even more common on ultrasound examination (about 25%).

  • About 5% of thyroid nodules are malignant.

  • Most thyroid cancers are well-differentiated papillary or follicular tumours with an excellent prognosis (10-year survival, 80%–95%).

  • The incidence of papillary thyroid cancer appears to be increasing on the east coast of Australia.

  • Fine-needle aspiration biopsy of the thyroid is the most cost-effective diagnostic tool.

  • Recommended initial management of all follicular carcinomas and of papillary carcinomas > 1.0 cm is total thyroidectomy followed by radioiodine ablation.

  • Most patients should be managed postoperatively with doses of thyroid hormone sufficient to suppress plasma levels of thyroid-stimulating hormone.

  • Recurrences can occur many years after initial therapy, and follow-up should be lifelong.

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  • Emily J Mackenzie1
  • Robin H Mortimer2

  • Department of Endocrinology, Royal Brisbane and Women’s Hospital, Brisbane, QLD.

Correspondence: 

  • 1. Burgess JR. Temporal trends for thyroid carcinoma in Australia: an increasing incidence of papillary thyroid carcinoma (1982-1997). Thyroid 2002; 12: 141-149.
  • 2. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiology 1991; 181: 683-687.
  • 3. Tan GH, Gharib H, Reading CC. Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med 1995; 155: 2418-2423.
  • 4. Belfiore A, La Rosa GL, La Porta GA, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med 1992; 93: 363-369.
  • 5. Sarne D, Schneider AB. External radiation and thyroid neoplasia. Endocrinol Metab Clin North Am 1996; 25: 181-195.
  • 6. Belfiore A, La Rosa GL. Fine-needle aspiration biopsy of the thyroid. Endocrinol Metab Clin North Am 2001; 30: 361-400.
  • 7. Tollin SR, Mery GM, Jelveh N, et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid 2000; 10: 235-241.
  • 8. Schlumberger MJ, Torlantano M. Papillary and follicular thyroid carcinoma. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14: 601-613.
  • 9. Burguera B, Gharib H. Thyroid incidentalomas. Prevalence, diagnosis, significance, and management. Endocrinol Metab Clin North Am 2000; 29: 187-203.
  • 10. Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: a 5-year follow-up. Radiology 2000; 215: 801-806.
  • 11. Alexander EK, Hurwitz S, Heering JP, et al. Natural history of benign solid and cystic thyroid nodules. Ann Intern Med 2003; 138: 315-318.
  • 12. Alexander EK, Heering JP, Benson CB, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 2002; 87: 4924-4927.
  • 13. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc 1994; 69: 44-49.
  • 14. Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002; 87: 4154-4159.
  • 15. Zelmanovitz F, Genro S, Gross JL. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses. J Clin Endocrinol Metab 1998; 83: 3881-3885.
  • 16. Cooper DS. Clinical review 66: thyroxine suppression therapy for benign nodular disease. J Clin Endocrinol Metab 1995; 80: 331-334.
  • 17. Mazzaferri EL. An overview of the management of papillary and follicular thyroid carcinoma. Thyroid 1999; 9: 421-427.
  • 18. Torrens JI, Burch HB. Serum thyroglobulin measurement. Utility in clinical practice. Endocrinol Metab Clin North Am 2001; 30: 429-467.
  • 19. Haugen BR, Lin EC. Isotope imaging for metastatic thyroid cancer. Endocrinol Metab Clin North Am 2001; 30: 469-492.
  • 20. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. American College of Endocrinology. Endocr Pract 2001; 7: 202-220.
  • 21. Modigliani E, Franc B, Niccolisire P. Diagnosis and treatment of medullary thyroid cancer. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14: 631-649.
  • 22. Giuffrida D, Gharib H. Anaplastic thyroid carcinoma: current diagnosis and treatment. Ann Oncol 2000; 11: 1083-1089.
  • 23. Burman KD, Ringel MD, Wartofsky L. Unusual types of thyroid neoplasms. Endocrinol Metab Clin North Am 1996; 25: 49-68.

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