Index

A prognosis of, 329–330 AACE. See American Association of Clinical prophylaxis for, 330 Endocrinologists (AACE) radiation and, 224 Abbreviations, 4–6 radiation complications and, 328 Absorbed radiation, 6, 199–200, 208, 315. See also symptoms of, 324 Radiation treatment of, 326–329 cumulative activity of, 207 radiation for, 327–328 Acne, 141 radioiodine and, 329 Acupuncture, 15 summary of, 329 Adenoma, 116 surgery for, 327 follicular, 65–66, 76, 85, 111 Anaplastic transformation, 322 paraganglioma-like, 65–66 Anesthetic. See General anesthetic; Local anesthetic Adenomatoid goiter. See Hyperplastic colloid Angiosarcoma, 85–86 nodule Antithyroglobulin antibodies, 192 Adenomatous hyperplasia, 62–65 Aplastic anemia, 148 AGES, 167, 201, 225 ATA. See American Thyroid Association formula for, 166 Autonomous nodule, 116, 154. See also Plummer’s Albumin, 36 disease Alternative therapy, 14–15 percutaneous injection of ethanol into, 119 American Association of Clinical Endocrinologists thyrotoxicosis and, treatment of, 116–117 (AACE), 13 American Thyroid Association (ATA), 13 B AMES, 166–167, 201 Baby. See also Fetus Amiodarone, 180 cancer in, 313, 317 Anaplastic carcinoma, 4, 79–80, 85, 88, 111, 143, 154, hypothyroidism and, 316 240, 248, 321–335 intelligence level of, 313, 317 chemotherapy and, 328 radiation exposure to, 308–309 children and, 296 B cell lymphoma, 84–85 clinical features of, 323 Benign tumor. See Nodule definition of, 79 Bleeding, 171 diagnosis of, 324 Bovine TSH, 175 etiology of, 321–323 Breast cancer, 238, 378–379, 381–382 experimental approaches to, 330–331 children and, 296 insular carcinoma and, 257 131I and, 221 131I therapy for, 222, 330 multimodality treatments for, 328–329 C pathology of, 323 Calcitonin, 49–50, 57, 60, 78, 81–82, 86, 151, 342–343, patient characteristics and, 323 346, 354, 357

385 386 Index

Calcitonin (cont.) 123I treatment in, 291 elevated levels of, 352 Levo-thyroxine and, 289 measurement of, 345 limited workup in, 286 cAMP. See Cyclic AMP lobectomy in, 286 Cancer seeking radiopharmaceuticals, 105–106 low iodine diet for, 291 Carcinoma, 1. See also Anaplastic carcinoma; lymph node metastases in, 287, 298 Insular carcinoma; Papillary carcinoma myelogenous leukemia in, 297 c-cell origin of, 80–82 NIS in, 287–288 embolization of, 244–245 nodules in, 109–110, 285–287 mucoepidermoid, 84 papillary carcinoma in, 287, 297 poorly differentiated, 78, 255 PET scan in, 295–297 primary squamous cell, 86 postoperative complications with, 289 retinoic acid and, 246 postoperative scans in, 293 word usage, 6 postoperative timeline with, 290 Carcinoma showing thymus-like element (CASTLE), prepubertal, 2 83 radiation and, 291 CAT scan. See CT scan radioiodine treatment for, 289–297 C cell, 87–88, 337–338, 341, 348, 357. See also controversies of, 296–297 Parafollicular cell RET proto-oncogene in, 347 hyperplasia and, 347–348 scintiscan of, 285 Cervical lymph node, 108 Sistrunk procedure in, 287 Chemotherapy, 197–198, 331, 370 stunning of, 291, 296 anaplastic carcinoma and, 328 thymus and, 295 medullary carcinoma and, 348–351 thyroglobulin and, 293, 296–297 Chernobyl reactor accident, 76, 97, 135–136, 145, thyroglossal cyst in, 287 157, 255 thyroid cancer etiology in, 284 adult incidence of thyroid cancer from, 146 thyroid cancer in, 283–302 children and, 284 incidence of, 284 papillary carcinoma from, 76, 146, 153–154 long-term management of, 294 quantities of radionuclides released from, 145 pathology of, 287–288 Chest scan, 190–191 rhTSH treatment for, 292–293 Children surgery for, 288–289 anaplastic carcinoma and, 296 treatment of, 288, 290–291 cancerous nodule in, 124 thyroidectomy in, 283, 286, 289, 297–298, 347 Chernobyl reactor accident and, 284 thyroid hormone and, 289–290 Cowden’s syndrome in, 296 thyroid nodule in, 297 differentiated thyroid cancer prognosis in, 297 diagnosis of, 285–287 external radiation in, 284 misdiagnosis of, 285 false positive scans in, 294 presentation of, 285–287 FNA in, 285–287, 297 thyroxine and, 290 follicular carcinoma in, 287 TSH and, 289 Gardner’s syndrome in, 296 ultrasound and, 293 hemithyroidectomy in, 288–289 Chronic lymphocytic thyroiditis. See Hashimoto’s Hodgkin’s disease in, 297 thyroiditis hypoparathyroidism in, 289 Cochran’s heterogeneity statistic (Q), 12 hypothyroidism in, 284 Coherent scatter, 150 131I treatment in, 283, 286, 289–290, 293, 298 Collimator, 188, 191 breast cancer after, 296 Colloid, 32–35, 50, 59, 62, 64 complications and long term problems with, nodule, 63–65, 96, 115 294–296 Comet tail, 107 dosage of, 291–292 Compton scatter, 149–151 fertility in, 294–295 Computed tomographic scan. See CT scan management after, 293–294 Confidence intervals, 8–9 nausea in, 294 equation for, 8 offspring of, 296 Core biopsy, 109 pregnancy testing prior to, 296 Cowden’s syndrome, 155, 261 reduced sperm count in, 295 children and, 296 stunning by, 291, 296 Cranial nerve XI, 28 Index 387

CT (computed tomographic) scan, 139, 157, 164, Endocrine gland, 21, 49 179, 184, 205, 238, 241–243, 257, 260, 344, Endocytosis, 35 350, 368–369, 380 Equilibrium-absorbed dose constant, 207–208 PET scan and, 239 Estrogen, 32, 36, 195, 303 sensitivity of, 238 thyroid cancer and, 157 Cumulative activity, 207 Ethanol, 122, 124 Cyclic AMP, 28–29, 45 intracystic injection of, 120 Cyst, 96, 106, 247 intranodular injection of, 119 causes of, 70 side effects of, 119 determination of, sensitivity and specificity of, Euthyroid, 98–100, 101, 116–117, 121, 180, 210–211, 69 253 midline, 70 pregnancy and, 308, 316 Cystic lesions, 70 Evidence-based medicine, 10–11 Cystic nodule, 110 basis of, 12 definition of, 10 D External clinical evidence, 10 Death rate, 2 Degrees of freedom (df), 12 F Deiodinase, 36–37, 39–40 False positive findings, 185–191 Depression Familial differentiated thyroid carcinoma, 154, 164, hypothyroidism and, 175 261–262 thyroid cancer and, 175 prognosis of, 261 De Quervain’s thyroiditis, 324. See also Subacute Familial medullary carcinoma, 80, 88, 97, 135, 152, thyroiditis 155, 337, 339, 347, 356–357 Diagnostic accuracy, 111–113 categories of, 15 Diagnostic scanning, 173–181, 236–237 mutations associated with, 341 hypothyroidism and, 173–175 Familial non-medullary carcinoma. See Familial 124I and, 209 differentiated thyroid carcinoma postoperative timeline, 174 Familial tumors, 81 preparation for, 173 Family history, 97 rhTSH and, 211 Fetal thyroid, 314 timing of, 231–232 Fetus. See also Baby Dialysis, 223–224 absorbed radiation in, 315 Diet, low iodine, 178–180, 231, 237, 257, 262 hypothyroidism in, 312–313 children and, 291 radiation and, 312–316 hypothyroidism and, 179 followup testing for, 313 new mothers and, 309 legal ramifications of, 315, 317 Differentiated thyroid cancer, 3, 155, 163–282, 225, Fine needle aspiration (FNA), 25, 58, 60, 63, 65, 68, 248, 261, 322, 331 79, 86–87, 96, 101, 105–113, 116, 124, 172, child’s prognosis for, 297 238, 240, 247, 249, 252, 256–258, 261, 285, controversy management concerning, 225 324, 342–343, 346, 349, 357–358, 365, 368, definition of, 163 371–372, 377, 380, 382 ectopic location of, 246–254 benign diagnosis from, 110 familial, 164, 261–262 children and, 285–287, 297 natural history of, 164–165 guided, 112–113, 120, 352 presentation of, 163–164 interpretation of, 110–111 prognoses of, 165 papillary carcinoma and, 72 variants of, 4, 74, 163, 262 pregnancy and, 305–306, 316 Dosimetry, 199, 202, 206–211, 221, 223 problems with, 111 badges for, 214 repeat of, 114 diagnostic 124I using, 209 sensitivity and specificity of, 111 Non-excessive marrow, lung and total body techniques for, 108–110 radiation and, 209–210 Follicle, 49, 59, 64 structure of, 28 E Follicle stimulating hormone (FSH), 175, 222 Empiric therapy for ablation of remnants, 201–204 Follicular adenoma, 65–66, 76, 85, 111 Empiric therapy for metastases treatment, definition of, 65 204–206 uncommon variants of, 66 388 Index

Follicular carcinoma, 3, 74, 76–78, 88, 100, 111, 114, Hashimoto’s thyroiditis, 68, 78, 84, 98, 101, 147, 192, 156, 163–164, 205, 244, 248, 251 240, 258, 365–366, 368, 371 children and, 287 primary thyroid lymphoma and, 367 familial, 154 HCG. See Human chorionic gonadotropin insular carcinoma and, 257 Hematolymphoid neoplasms, 84–85 metastatic, 164, 252 Hematoma, 262 poorly differentiated, 78–79 formation of, 109 variants of, 88, 258–261 postoperative occurrance of, 171 Follicular cell, 29–30, 33–35, 57, 62, 87–88, 173, 262, Hodgkin’s lymphoma, 85, 135, 136, 240 284, 321 children and, 297 Follicular lesions, 65 Hormone. See Thyroid, hormones of Free-3,5,3¢,5¢ tetraiodothyronine, 5 Horner’s syndrome, 27–28 FSH. See Follicle stimulating hormone Human apical iodide transporter, 33 FT4, 4, 196, 210, 305 Human chorionic gonadotropin (HCG), 175, 304, 314 index formula for, 303 Hürthle cell carcinoma, 63, 65, 68, 78, 81, 88, 104, 111, 154, 205, 240, 248, 255, 258–261, 262, G 321, 324 Gallium-67 (67Ga), 105, 148, 368 clinical features of, 259 Gardner’s syndrome, 155 diagnosis of, 259 children and, 296 familial, 155 Gastrointestinal tract, 29 papillary carcinoma and, 76 General anesthetic, 240 patient characteristics of, 259 inherent risks of, 172 prognosis of, 260 Genetic engineering, 50 summary of, 260 Glucose, 238–239 thyroid carcinoma and, 260–261 Goiter, 23, 29–30, 46, 104, 122, 124, 247, 304–305, 331, treatment of, 259–260 365, 371 Hürthle cell neoplasm, 258–259 asymptomatic, 121 Hyalinizing trabecular, 65–66, 83 causes of, 62 Hydrogen peroxide, 35 multinodular, 23, 76, 86, 102–104, 107, 125, 155, Hyperparathyroidism, 337, 343, 357 322, 378 Hyperplastic colloid nodule, 63–65, 96 cancer incidence in, 98 Hyperthyroidism, 23, 30, 63, 66, 101–102, 120, 125, management of, 120–122 143, 246, 312. See also Graves’ nontoxic, 62–65 hyperthyroidism; Jod Basedow disease pregnancy and, 304–305 Hypocalcemia, 168, 171 rhTSH therapy for, 178 acute, 27 toxic, 121, 125 pregnancy and, 308 nodular, 78, 102, 115, 121, 155, 331 temporary, 27 substernal or retrosternal, 122–124 Hypoparathyroidism, 168, 171, 262 toxic, 116, 119, 122 avoidance of, 27 nodule formation in, 23 children and, 289 retrosternal, 23, 122–124 131I and, 220 sporadic, 63–65 pregnancy and, 307–308 substernal, 23, 122–124 Hypothalamic pituitary thyroid axis, 42 thyrotoxicosis in, 124 Hypothalamus, 39 substernal or retrosternal, 122–124 thyrotropin and, 42–44 toxic and nontoxic, 63 Hypothyroidism, 30, 32, 34–35, 44–45, 68, 101, 104, G-protein coupled receptor, 42, 44–45 118, 120, 122, 141, 143, 147, 171, 173–175, Graves’ hyperthyroidism, 25–26, 30, 34–35, 209–210, 237, 247, 284, 366 45–46, 62, 78, 100–101, 116, 119, 121, depression and, 175 125, 135–136, 141, 143, 192, 258, 365, neonatal, 147 377 rhTSH treatment for, 211 Graves’ orbitopathy, 141 Gross anatomy. See Thyroid, anatomy of I ICD-9-CM Coding System, 16 H ICRP. See International Commission on Radiation Half-life, 200 Protection and Measurements Halo, 107 Immunohistochemistry, 60–61, 87 Index 389

Immunoradiometric assay (IRMA), 192–193 dosage of, 291–292 Incidentalomas, 95–96, 112 fertility in, 294–295 Incision size, 169 management after, 293–294 Insular carcinoma, 78, 255 nausea in, 294 anaplastic carcinoma and, 257 offspring of, 296 clinical features of, 255–256 pregnancy testing prior to, 296 distant metastases and, 256 reduced sperm count in, 295 external radiation and, 258 stunning by, 291, 296 follicular carcinoma and, 257 dosage formula for, 121 management of, 256–257 dosage of, 117–118 papillary carcinoma and, 257 down sides to, 237–238 prognosis of, 257–258 effect on fertility and offspring of, 310–311 Insulin regulation, 33 geometric mean formula of, 209 International codes for thyroid diseases, 16 half-life of, 168 International Commission on Radiation Protection high dose therapy of, 203 and Measurements (ICRP), 206, 208–209, history of treatment with, 198 221 hypoparathyroidism and, 220 Interobserver reliability, 9 leukemia and, 220–221 Interobserver variation, 75 liquid or capsule therapy of, 212 Intraobserver reliability, 8 low dose outpatient therapy of, 202 Intraoperative consultation, 60 maximum outpatient dosage of, 201 Intraoperative evaluation, 59–60 medullary carcinoma and, 348 Intrathyroidal thymoma, 82–83 necessity of, 227–228 Intravenous contrast. See Radiographic contrast new mothers and, 309 Iodine, 29–30, 33–34, 46, 48–49, 49, 62, 96, 102, nodule treatment with, 117–119 115–116, 121, 140, 147–148, 177–178, 183, physical characteristics of, 208 197, 321 physicians checklist for treatment with, 215 decay of, 185 pregnancy and, 307–309, 316 deficiency of, 29 proponents of, 237 diet to reduce presence of, 178–180, 231, 237, 257, renal disease and, 223–224 262, 291, 309 side effects and complications of, 217–223 hypothyroidism and, 179 bladder cancer, 221 further metabolism of, 32 breast cancer, 221 inorganic, 147, 156 early or late occurring, 218 radioactive, 146–147 fertility, 221–222 exposure reduction to, 148 fibrosis, 223 recommended intake for, 29 hypoparathyroidism, 220 urinary, 179–180 lacrimal duct blockage, 220 whole-body uptake of, 183–184 leukemia, 220–221 Iodine induced hyperthyroidism. See Jod Basedow miliary metastases, 222–223 disease miscarriage, 222 131I, 24, 30–32, 34, 36–38, 46, 48, 68, 100, 102, 114, 116, radiation pneumonitis, 223 120, 122–125, 138, 140, 143, 164–165, 172, radiation thyroiditis, 218–219 176–177, 180–181, 184, 188, 194, 197, 205, reduced testicular function, 222 210, 227, 242, 245–246, 248, 251, 257, sialadenitis, 219–220 261–262, 316, 348, 352–353. See also stroke, 218 Patient, radioactive thyrotoxicosis, 219 algorithm for treatment with, 199 vomiting, 218 alternatives to, 224–225 stunning with, 228–235, 291, 296 anaplastic carcinoma and, 222, 330 therapeutic uptake formula for, 181 benefits of, 225–227 therapy with, 11 meta-analysis of, 226 release regulations for, 204 breast cancer and, 221 thyroglobulin and, 235–246 children’s treatment with, 283, 286, 289–290, 293, thyrotoxicosis and, 219 298 treatment followup for, 224 breast cancer after, 296 treatment principles for, 198–199 complications and long term problems with, uptake increase of, 246 294–296 124I, 209 390 Index

127I, 29, 146, 157, 179 Lymphoma, 4, 88, 101, 156–157, 238, 240, 322, 367, 123I, 102, 140, 168, 172, 180–181, 183, 353 372 children and, 291 B cell, 84–85, 369–371 pregnancy and, 309, 315 Hodgkin’s, 85, 135, 136, 240 IRMA. See Immunoradiometric assay (IRMA) children and, 297 Isthmusectomy, 227 malignant, 84 lobectomy and, 114 non-Hodgkin’s, 365 pathological variants of, 366 J primary, 365–375 Jod Basedow disease, 116, 121, 147 clinical features of, 366–367 diagnosis of, 367–368 K differential diagnosis of, 368 Kappa Score (K), 8 local symptoms and, 367 equation for, 9 management of, 370–372 Keloid scars, 172, 262 pathology of, 365–366 KI. See Potassium iodide prognosis of, 372 Kidney, 29, 378–379, 381–382 workup for, 368–369 Kocher incision, 169 M L MACIS, 167–168, 201, 225, 227–228 Lateral aberrant thyroid, 25 formula for, 166 Lesion, 57 Maldescended thyroid, 25 benign, 62 Malignant tumor. See Carcinoma cystic, 70 MALTomas. See Mucosa-Associated Lymphoid follicular, 65 Tissue miscellaneous, 70–71 Marine-Lenhart syndrome, 101 PET identification of, 240–244 MCT. See Monocarboxylate transporter radioactive iodine in, 245–246 Medical Internal Radiation Dose committee of the treatment of, 240–245 Society of Nuclear Medicine (MIRD), 200, vascular, 108 206–207 vertebral, 245 Medullary carcinoma, 4, 57, 60, 80–83, 88, 97, 110, Leukemia, 226 151, 240, 261, 337–363 131I and, 220–221 categories of, 15 myelogenous, 297 characteristics of types of, 356 Levo-thyroxine, 4, 48, 102, 118, 121–122, 125, 168, chemotherapy and, 348–351 174–175, 178–180, 192, 196, 203, 222, 228, clinical features of, 342–344 250, 262, 311, 316 detection of, 353 children and, 289 diagnosis of, 344–346 generic medication of, 196 differentiated cancer and, 351 pregnancy and, 307–308 distant metastases and, 349 LH. See Luteinizing hormone etiology of, 339–341 Likelihood ratio, 7–8 familial, 80, 88, 97, 135, 152, 155, 337, 339, 347, equation for, 8 356–357 Lingual thyroid, 24–25 categories of, 15 cancer in, 250 mutations associated with, 341 Lithium, 246 followup to, 351–352 thyroid alterations and, 246 genetic testing in, 344–346 Lobectomy, 10, 114, 124–125, 168, 172, 219, 225, histologic patterns of, 82 227–228, 256–257 historical prospective of, 338–339 children and, 286 131I treatment for, 348 isthmusectomy and, 114 management of, 347, 349 Lobules, 28 neoplasms present with, 82 Local anesthetic, 108, 172, 240 non-familial, 356 L-T4,4 pathology of, 341–342 L-thyroxine, 4 patient characteristics in, 356 Lung cancer, 378–379, 381, 382 postoperative radiation and chemotherapy for, Luteinizing hormone (LH), 175 348–351 Lymphocytic thyroiditis, 156–157 prognosis of, 355–357 Index 391

staging of, 344 routine FNA repeat for, 113 treatment of, 346–348 cancerous, 124 future directions of, 355 symptoms of, 98 variants of, 82 children and, 109–110, 297 Memorial Sloan-Kettering Cancer Center cancerous, 124 Classification (MSKCC), 166 diagnosis of, 285–287 Mesenchymal tumors, 85–86 misdiagnosis of, 285 Meta-analysis, 12, 102, 115, 195 presentation of, 285–287 benefits of, 226 clinical features of, 96–98 Microcalcifications, 107 colloid, 63–65, 96, 115 Midline cysts, 70 cystic, 110, 114, 120, 125 MIRD. See Medical Internal Radiation Dose diagnostic testing for, 98 committee of the Society of Nuclear diagnostic testing of, 98 Medicine dominant, 125 Miscellaneous tumors of divergent origin, 82–84 formation of, 23, 62, 87 Mitochondria, 42, 65, 342 functioning, 104, 116 thyroid hormone and, 39 131I treatment of, 117–119 Monocarboxylate transporter (MCT), 39 hyperplastic colloid, 63–65, 96 MSKCC. See Memorial Sloan-Kettering Cancer hyperthyroid, dosage calculation of 131I for, 118 Center Classification 131I treatment for, 117–119 Mucoepidermoid carcinoma, 84 large, symptoms of, 96 Mucosa-Associated Lymphoid Tissue (MALTomas), malignant, 98–99, 113 84–85 management of, 113–114 Multiple Endocrine Neoplasia 2A (MEN 2A), nontoxic, treatment of, 120 151–152, 157, 261, 337, 339–340, 343, 345, occurrence of, 3 347–348, 353, 356–357 pain and, 96 exon and codon sequences of, 153 pregnancy and, 305–307, 316 Multiple Endocrine Neoplasia 2B (MEN 2B), third trimester and, 307 151–152, 157, 261, 337, 339–340, 343–345, workup for, 306 347, 353, 356–358 thyrotoxicosis and, 116–117 exon and codon sequences of, 153 tumor-like, 62 thyroidectomy and, 348 Non-Hodgkin’s lymphoma, 365 Multivariate statistics, 166, 171 Non-radioactive iodine (127I), 146, 157, 179. See 127I Nontoxic multinodular goiter, 62–65 N Negative likelihood ratio, 8 O Neonatal hypothyroidism, 312–313 Operation. See Thyroidectomy New mothers Organic anion transporting polypeptide (OATP), 39 131I treatment for, separation from infant and, 309 Osteogenic sarcoma, 225, 261 low iodine diet and, 309 Ovarian neoplasm, 250–252 whole-body scan and, 309 Oxytocin, 32 9-cis-retinoic acid, 245 9-cis-retinoic receptor (RXR), 39, 245 P NIS. See Sodium iodine symporter p53, 154, 322, 331 Nodular goiter, 78, 102, 115, 121, 155, 331. See also mutation in, 256 Goiter Paclitaxel (Taxol), 328 substernal or retrosternal, 122–124 Paired box gene (PAX-8), 33–34 toxic, 116, 119, 122 Pair production, 149–151 Nodular hyperplasia. See Adenomatous hyperplasia Papillary carcinoma, 3, 57–60, 66, 68, 70–76, 86, 88, Nodule, 6, 35, 48, 58–60, 66, 68, 86–87, 95–96, 103, 98, 100, 113, 142–143, 146, 153–155, 106–107, 119, 124, 252, 256, 261, 304–305, 163–164, 167–168, 192, 205, 227–228, 244, 349, 358, 379, 382. See also Plummer’s 248, 252, 262, 342 disease Chernobyl reactor accident and, 76, 146, 153–154 age and, 96–97 children and, 287, 297 autonomous, 116, 154 columnar cell variant of, 254 percutaneous injection of ethanol into, 119 clinical features of, 254 thyrotoxicosis, 116–117 prognosis of, 254–255 benign, 62, 114 treatment of, 254 392 Index

Papillary carcinoma (cont.) Pendred’s syndrome, 32 conventional, 73 Pentagastrin, 345 cystic, 110 PET (positron emission tomography) scan, 104–106, cytology of, 110 117, 138, 238–242, 257, 260, 295, 325–326, diffuse sclerosing variant, 76 350, 352–353, 368–370, 380 familial, 97, 154, 156 children and, 295–297 fine needle aspiration for, 72 CT scan and, 239 follicular variant of, 78, 104, 111, 114, 252, 253 false positives in, 354 histologic variants of, 74–76 fluorine-18 deoxyglucose and, 353–355 histology of, 110 method of, 353 Hürthle cell variant of, 76 sensitivity of, 353 insular carcinoma, 257 lesion identification by, 240–244 low risk, 236 patient preparation for, 239 occult, 74 potential false positives from, 239–240, 243 patterns in, 75–76 thyroid cancer and, 239 pregnancy and, 307 TSH and, 239 solid or trabecular variant of, 255 Pharynx, 24 clinical features of, 255 Photodisintegration, 150 prognosis of, 255 Photoelectric effect, 149, 151 treatment of, 255 Physician uncertainty, 283 sonographic features of, 107 Pituitary gland, 39, 42, 44–45 spread of, 72–73 Plummer’s disease, 116–117, 119, 154 tall cell variant of, 253 Poorly differentiated cancer. See Insular carcinoma clinical features of, 253 Positron emission tomography. See PET scan prognosis of, 254 Postoperative diagnostic scanning timeline, 174 treatment of, 253–254 Postoperative tumor, node, metastasis staging variants of, 75, 84, 88, 252 (pTNM), 165–166 Parafollicular cell, 35, 57, 337. See also C cell Post test odds, 8 Paraganglioma-like adenoma, 65–66 Potassium iodide (KI), 146–147 Parathyroid glands, 27, 371 Potassium perchlorate (KclO4), 148 identification of, 171 Pregnancy, 36 inferior, 27 calcium and, 308, 311, 316 superior, 27 cancer effects on, 311–312 Pathologist euthyroid and, 308, 316 diagnostic tools of, 58 FNA and, 305–306, 316 role of, 58–60 FT4 and, 311 Patient, 1–2, 211 goiter, multinodular, 304–305 anaplastic carcinoma hypocalcemia and, 308 chacteristics of, 323 hypoparathyroidism and, 307–308 symptoms of, 324 hypothyroidism and, 308 Hürthle cell carcinoma, characteristics of, 259 131I and, 307–309, 316 medullary carcinoma, characteristics of, 356 131I treatment and, 307 personal history of, 97–98 breast feeding and, 308–309 primary lymphoma, workup for, 368–369 123I and, 309, 315 radioactive 123treatment and, 309, 315 allowed emission levels for, 212–213 levo-thyroxine and, 307–308, 311, 316 European regulations for release of, 213 nodule and, 305–307, 316 formula for allowed proximity to, 213 third trimester and, 307 notice outside room of, 217 workup for, 306 nurses instructions for caring for, 216 papillary cancer and, 307 nursing required for, 213–214 radioiodine and, 30, 308, 316 outpatient instructions for, 214 sodium iodide symporter and, 308 regulations for release of, 212–217 surgery during, 306–307, 316 United States regulations for release of, 212–213 thyroglobulin and, 308–309, 315 thyroglossal cyst cancer, characteristics of, 248 thyroid cancer and, 303–320 thyroglossal duct cysts and, 249 management prior to, 310 thyroid cancer, sodium iodine symporter in, 32 thyroid cancer during, 316 Patient-physician relationship, 13–14 late term management of, 314–315 PAX-8. See Paired box gene (PAX-8) prognosis of, 316 Index 393

treatment of, 307–310 internal, 145, 157 thyroidectomy and, 307 medical, diagnostic and theraputic procedures thyroid function during, 305, 311 using, 140, 143 thyroid hormone and, 308, 311 medullary carcinoma and, 348–351 thyroid nodule and, 305–307, 316 mother to fetus and, 314 third trimester and, 307 occupational exposure workup for, 306 medical, 143–144 thyroid tests during, 304 nuclear power plants, 144 thyrotoxicosis and, 308 pneumonitis, 223 treated thyroid cancer and, management of, 311 potential exposure to, 136 verification of, 315–317 pregnancy, internal radiation and, 312–316 legal ramifications of, 315, 317 side effects of, 198 working with 131I during, 316 stochastic and non-stochastic effects of, 149 Prepubertal children, 2 terms and definitions related to, 136–138, 200 Pretest odds, 7–8 thyroid Primary squamous cell carcinoma, 86 absorbed radiation to, 199–200 Prion-induced diseases, 175 radiation exposure to, 68 Prognostic indices, 165–167 thyroid cancer caused by, 135–136, 200 Prolactin, 32 thyroiditis, 68–69, 203, 218–219 pTNM. See Postoperative tumor, node, metastasis tissue effects of, 149 tissue response to, 148–151 Q treatment with, increased thyroid cancer Q. See Cochran’s heterogeneity statistic following, 141 types of, 137 R Radiation physics, 199–201 Radiation, 97–98, 117, 120, 124, 157, 206–207, Radioactive excreta, 213 348–351, 349, 350 disposal of, 212 absorbed, 6, 118, 199–200, 208, 315 Radioactive fallout, 146–148 cumulative activity of, 207 Radioactive iodine, 172, 179, 237, 245, 322. See also absorbed fraction, 208 131I; Radioiodine accidental release from power plants of, Radioactive tracer, 180–181 145–146 Radiographic contrast, 179 anaplastic carcinoma and, 224, 327–328 Radioimmunoassay, 192–193 atomic bomb, testing of, 144–145 Radioiodine, 30, 32, 34, 46, 48, 69, 118, 120–121, 124, baby and, 308–309 141, 178, 180, 185, 211, 314, 329 carcinogenesis and, 315 anaplastic carcinoma, radioiodine treatment of, children and, 284, 291 329 common exposure levels of, 139 children and, 289–297 cumulative activity of, 207 controversies of, 296–297 direct and indirect effects of, 150–151 pregnancy and, 30, 308, 316 dosimetry and, 209–210 treatment with, 197–224 effects of, 149–151 Radionuclides of iodine, 138–139, 197 embryogenesis and, 315 half-life formula for, 200 emission problem in United States of, 215–217 Randomized controlled studies, 11 energy and, 137 RAR. See Retinoic acid receptors equilibrium-absorbed dose constant, 207–208 Received operator characteristics, 9–10 exposure to, 139–148 Receiver operator characteristic curve (ROC), 10 external, 157, 172, 221, 224–225, 240, 244, 248, 258, Recombinant human thyrotropin (rhTSH), 30, 122, 284, 322, 327–328, 329, 331 125, 175–179, 224, 262. See also Thyroid effect of, 140–141 stimulating hormone medical, diagnostic, and theraputic procedures antibody development to, 178 using, 139–143 children and, 292–293 side effects of, 244 diagnostic scanning preparation with, 211 fetus and, 312–316, 315 FDA approval of, 176 followup testing for, 313 radioactive half-life of, 210–211 legal ramifications of, 315, 317 side effects of, 176 heart disease and, 139–140 subcutaneous injection of, 178 hormesis, 148 treatment after stimulation with, 210–211 Insular carcinoma and, 258 treatment with, 210 394 Index

Recurrent laryngeal nerves, 26–27, 170, 240 Sternocleidomastoid, 21–22 paralysis of, 262 Struma ovarii Redifferentiation of cancer, 145–146 benign, 251 Reidel’s thyroiditis, 70, 324 malignant, 250–252 Renal disease, 131I treatment and, 223–224 questions concerning, 251 Retinoic acid, 245–246, 329 Studies. See Randomized controlled studies Retinoic acid receptors (RAR), 245 Stunning, 228–235 Retinoid X receptors (RXR), 245 alternative explanations for, 233–234 RET proto-oncogene, 151–153, 157, 337–338, children and, 291, 296 344–347, 351, 357 physicians against, 235 children and, 347 physicians in support of, 232 coding for, 152 summary of, 233–234 mutation in, 157 support for, 234 rhTSH. See Recombinant human TSH in vitro, 232–233 RXR. See 9-cis-retinoic receptor; Retinoid X Subacute thyroiditis, 69, 98, 101, 324 receptors Superior laryngeal nerves, 27, 171 Surgical anatomy, 26–28 S Surgical procedure, 168–169 Sample adequacy, 59 complications of, 169–172 Scanning. See Diagnostic scanning parathyroid glands identification during, 171 Scintigraphy, 101–105, 220, 247, 352–353, 368 recurrent nerve identification in, 170 Scintiscan, 122–124, 150, 183–184, 211, 225, 238, 256 surgeon selection for, 168–169 process of, 102–104 Surgical treatment, 169 resolution of, 104–105 Système International (SI), 6, 135, 137 Sensitivity, 8–9 definition of, 6 T equation for, 7 T3, 5, 36–37, 39–42, 44, 48, 50 Sentinel node imaging, 26 T4, 4, 36, 37, 38, 39, 41, 42 SETTLE. See Spindle epithelial tumor with thymus- free, 4, 196, 210, 305 like element index formula for, 303 Single photon emission computed tomography pregnancy and, 311 (SPECT or SPET), 104–105 Taxol. See Paclitaxel Sistrunk procedure, 248 TBG. See Thyroid binding globulin 99m children and, 287 Technetium pertechnetate ( TcO 4), 102, 105, 116, thyroglossal cyst cancer and, 248 123, 181, 220 Small-bore needle, 109 Terminology, 4 Sodium iodine symporter (NIS), 29–34, 49–50, 102, Test result interpretation, 6–8 148, 172–173, 304, 329, 331, 379 Tg. See Thyroglobulin children and, 287–288 3,5,3¢,5¢ tetraiodothyronine, 5 expression in other tissues of, 32 Thymus, 141, 188, 295 mutations of, 30 Thyrogen. See Recombinant human thyrotropin pregnancy and, 308 Thyroglobulin (Tg), 29, 35–36, 44, 50, 65, 68, 73, 78, structure and function of, 30 82–83, 86, 163, 168, 176–177, 185, 192–194, TSH and, 173 224, 228, 235, 237, 245, 252, 257, 262, 343, Specificity, 8–9 371, 379 definition of, 6 assays, 192–193 equation for, 7 children and, 293, 296–297 SPECT. See Single photon emission computed composition and function of, 192 tomography high dose 131I and, 236–238 SPET. See Single photon emission computed 131I and, 235–246 tomography management by waiting and monitoring, 236 Spinal accessory nerve, 28 main role of, 192 Spindle epithelial tumor with thymus-like element measurement of, 49 (SETTLE), 83 measurement sensitivity of, 193 Sporadic cancer, 81, 155, 157, 261, 337 messenger ribonucleic acid and, 193–194 Staging indices, 165–167 normal levels of, 193 Standard system, 6, 137 pregnancy and, 308–309, 315 Statistics, 6–8 production of, 192 Index 395

Thyroglossal cyst, 70, 247, 248, 249 side effects of, 123 children and, 287 nodule, 95, 103, 107, 124, 256, 261, 349, 358, 379, differential diagnosis of, 25 382 Thyroglossal cyst cancer, 249–250 benign, 62 patient characteristics with, 248 in children, 109–110 treatment with Sistrunk procedure for, 248 clinical features of, 96–98 Thyroglossal duct cysts, 25 diagnostic testing of, 98 clinical examination of, 249 malignant, 98–99 treatment and outcome of patients with, 249 management of, 113–114 Thyroid, 29, 112, 168, 243, 251, 304, 342, 367, 370 pregnancy and, 305–307, 316 abscess of, 66–68 third trimester and, 307 absorbed radiation to, 199–200 workup for, 306 anaplastic carcinoma of, 321–335 nodule formation in, 23, 62, 87 anatomy of, 21–23, 62 normal development of, 24 arterial flow to, 377 normal function of, 325 atypical positioning of, 252–253 normal variation of, 23 autoregulation of, 46 palpation of, 22 blood supply of, 2 papillary carcinoma sonographic features of, 107 cyst fluid from, 69 pathology, 57–94 cysts of, 69–70 physiology of, 21–22 ectopic, 24–25, 252–253 pregnancy and, tests during, 304 embryology, 24–26 primary lymphoma of, 365–375 embryology of, 24–26 clinical features of, 366–367 enlarged, 23 diagnosis of, 367–368 epithelial elements of, 86 differential diagnosis of, 368 follicular cells of, 29–30, 33 local symptoms and, 367 formation of, 24 management of, 370–372 functional developmental stages of, 24 pathology of, 365–366 function of, 42, 98–101 patient workup and, 368–369 changes in, 303–304 prognosis of, 372 testing of, 48–49 radiation and, 68, 135–136, 199–200 gland stimulation in, 25 scintigraphy of, 100–106 hormone formation in, 24, 29–30, 33 test of function of, 44 hormone function in, 42 transcription factors of, 24 hormones of, 4, 21 ultrasound of, 106–108 hyperfunctioning of (See Graves’ United States and, 15 hyperthyroidism) Thyroid binding globulin (TBG), 36, 50 increased iodine retention in, 246 changes in, 303–304 lateral aberrant, 25 Thyroid cancer, 1, 25, 29–30, 32, 34, 36, 38, 42, 44, 48, lesions of, 57, 380 61, 84, 88, 95–96, 98, 101, 105, 112, 114, 139, lingual, 24–25 146, 155, 157, 168, 178, 180, 192, 202, 221, lobules of, 28 238, 247, 251, 261, 338–339, 372 location of, 21 chemical causes of, 156 lymphatic supply of, 26 Chernobyl reactor accident and, 146 lymphoma of, 4 children and, 283–302 maldescended, 25 differentiated prognosis in, 297 malignancies special issues of, 86–87 etiology of, 284 medications affecting, 70–71 incidence of, 284 mesenchymal neoplasms of, 85 long-term management of, 294 metastases to, 86, 199, 377–384, 382 pathology of, 287–288 autopsy incidence of, 377 rhTSH treatment for, 292–293 diagnosis of, 378–379 surgery for, 288–289 management of, 379–381 treatment of, 288, 290–291 prognosis of, 381 codes for disease classification of, 16 microscopic structure of, 28–29 demographics of, 15 migration of, 25 depression and, 175 miscellaneous lesions of, 70–71 diagnostic categories of, 59 movement of, 122 dialysis and, 223–224 396 Index

Thyroid cancer (cont.) Thyroid epithelial elements, 86 differentiated, 3, 49, 57, 71, 155, 163–282, 225, 248, Thyroid hormone, 4, 21, 34, 44, 102, 115, 165, 178, 261, 322, 331 193, 227 child’s prognosis for, 297 action of, 39–42 controversy management concerning, 225 active transport of, 39 definition of, 163 binding and transport of, 36 ectopic location of, 246–254 carriage in blood of, 36 familial, 154, 164, 261–262 children and, 289–290 natural history of, 164–165 control and production of, 47 presentation of, 163–164 effects of, 42–43 prognoses of, 164, 165 effects on mitochondria and cell membranes of, variants of, 4, 74, 163, 262 39 epidemiology of, 1–3 excess, 195–196 estrogen and, 157 formation in, 24, 29–30, 33 ethnic demographics of, 2 function in, 42 etiology of, 135–157 metabolism of, 36–39 role of iodine in, 156–157 Mitochondria and, 39 familial non medullary, 154–156 negative feedback of, 37 gender distribution of, 2 pregnancy and, 308, 311 genetic mutations as a cause of, 151–156 promoter region of genes activated by, 39 histological types of, 156 receptor, 41, 50 immunohistochemical testing of, 60 reduced bone density resulting from, 194–195 incidence of, 2 release into blood of, 35 increased screening for, 142–143 storage of, 29 management of, 26 structure of, 37 management prior to pregnancy, 310 therapy, 48 mixed columnar cell, tall cell, and Hürthle cell thyroidectomy and, 194 variants, 260–261 treatment start time for, 196 mortality for, 226 treatment with, 114–116, 194–197 PET scan and, 239 disadvantages of, 115–116 pregnancy and, 303–320 studies of, 114–115 effects on, 311–312 Thyroiditis, 168 late term management of, 314–315 acute, 66–68 prognosis of, 316 De Quervain’s, 324 treatment of, 307–310 Hashimoto’s, 68, 78, 84, 98, 101, 147, 192, 240, 258, pTNM staging of, 165 365–366, 368, 371 radiation and, 135–136, 141, 200 primary thyroid lymphoma and, 367 sodium iodine symporter and, 32 lymphocytic, 156–157 spreading of, 184 painful, 143 survivor organization, 12–13 radiation, 68–69, 203, 218–219 types of, 57, 58 Reidel’s, 70, 324 United Kingdom and, 2 silent, 141 United States and, 15 silent radiation, 143 waiting and monitoring, 236 subacute, 69, 98, 101, 324 Thyroidectomy, 10, 25–26, 44, 49, 60–61, 65, 78, types of, 67–70 100–101, 114, 121, 124–125, 164, 167–168, Thyroid neoplasia, 61 170, 183, 192, 202, 219, 227–228, 240, Thyroid receptor a (TRa), 39–40, 50 248–249, 251–252, 256, 261–262, 307, 321, Thyroid receptor b (TRb), 39–40, 50 327, 331, 338, 354, 357–358, 371 Thyroid response elements (TRE), 39, 50 administration of thyroid hormone after, 194 Thyroid stimulating hormone (TSH), 24, 28, 30, children and, 283, 286, 288–289, 297–298, 347 33–35, 37, 42, 44–45, 48, 62, 68, 101, complications of, 27 115–116, 119, 122, 143, 154, 168, 174–175, percentages of, 170 193–194, 196, 235, 237, 247, 252, 257, 262, MEN 2B and, 348 304, 309, 338 pregnancy and, 307 bovine, 175 residual thyroid after, 194 children and, 289 thyroid hormone and, 194 NIS expression controlled by, 173 video-assisted, 169, 172 PET scan and, 239 Index 397

receptor for, 45–46 definition of, 6 antibodies to, 46 familial, 81 chromosomal location of, 45 mesenchymal, 85–86 function of, 45 metastatic, 87, 260 mutations of, 45–46 miscellaneous, 82–84 transmembrane folding of, 45 SETTLE, 83 receptors for, 28 Tyrosine kinase, 151–153, 340, 357 secretion regulation of, 45 Tyrosine kinase gene (TRK), 61 Thyroid stimulating immunoglobulins (TSI), 28, 46 Thyroid transcription factor one (TTF-1), 33–34, 60, U 65, 78, 81 Ultrasound, 106–108, 112–113, 117, 120, 124, 238, Thyroid transcription factor two (TTF-2), 33 240, 247, 249 Thyroperoxidase (TPO), 33–35 children and, 293 forms of, 34 United Kingdom, 119 mutations in, 34–35 increased mortality in, 3 Thyrothymic thyroid rests, 25 survival rates in, 3 Thyrotoxicosis, 101, 116, 143, 147, 164, 194–195, 203, thyroid cancer cases in, 2 251, 324, 367, 378 United States, 30, 62, 78, 119–120, 136–137, 139, 145, autonomous nodule and, 116–117 178, 201, 211–212, 284, 289, 304–305, 316, 131I and, 219 345 menstruation and, 310–311 demographics of cases in, 95–96 pregnancy and, 308 increasing incidence of thyroid cancer in, substernal goiter and, 124 15 worsening of, 118–119 iodine intake for, 29 Thyrotropin releasing hormone (TRH), 42, 44 new cases annually in, 87–88, 95–96 Thyroxine, 4, 21, 30, 34, 36, 179, 194 radiation emission problem in, 215–217 children and, 290 radioactive patient release in, 212–213 Toxic nodular goiter, 116, 119, 122 survival rates in, 3 Toxicosis, 102. See also Thyrotoxicosis Units of measurement, 6 TRa. See Thyroid receptor a Univariate statistics, 166 Trabecular components, 72 Trachea, 109, 244 V Traditional herbal therapy, 15 Vascular lesions, 108 Transcription factors, 33, 45 Venous blood (deoxygenated blood), 355 Transthyretin, 36 Vertebral lesion, 245 TRb. See Thyroid receptor b Vitamin A derivatives, 245 TRE. See Thyroid response elements Vocal cord paralysation, 27 Treatment choice, 119–120 Treatment fundamentals, 167–168 W TRH. See Thyrotropin releasing hormone Whole-body scan, 184, 187–190, 193, 199, 201, TRH-degrading ectoenzyme, 44 203–204, 206, 210, 223, 225, 235, 242, 248, Triiodothyronine, 21, 30, 32, 34, 42, 48, 174, 175, 178, 252, 256, 262, 309, 325 179, 180, 196 false positive findings and, 182–183 TRK. See Tyrosine kinase gene interpretation of, 181–185 True agreement. See Kappa score negative, 185, 326 TSH. See Thyroid stimulating hormone new mothers and, 309 TSI. See Thyroid stimulating immunoglobulins normal patterns and, 184 TTF-1. See Thyroid transcription factor one positive, 186 TTF-2. See Thyroid transcription factor two transmission scan and, 181 Tumor. See also Nodule Wolf-Chaikoff effect, 48 benign, 62 World Health Organization (WHO), 66