Table Of ContentDavid S. Cooper
Cosimo Durante
Editors
Thyroid Cancer
A Case-Based
Approach
123
Thyroid Cancer
David S. Cooper • Cosimo Durante
Editors
Thyroid Cancer
A Case-Based Approach
Editors
David S. Cooper , MD Cosimo Durante , MD
Division of Endocrinology Department of Internal Medicine
Diabetes, and Metabolism and Medical Specialties
The Johns Hopkins University University of Rome “Sapienza”
School of Medicine Rome , Italy
Baltimore , MD , USA
ISBN 978-3-319-22400-8 ISBN 978-3-319-22401-5 (eBook)
DOI 10.1007/978-3-319-22401-5
Library of Congress Control Number: 2015953101
Springer Cham Heidelberg New York Dordrecht London
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Pref ace
There have been few instances in the fi eld of thyroidology as startling and dramatic
as the epidemic of differentiated thyroid cancer in virtually all developed and devel-
oping countries around the world. Whether this is due, as many suspect, to increases
in radiologic procedures and screening, or to environmental factors, such as radia-
tion, or both continues to be a matter of intense debate. However, for the clinicians
caring for the large number of new and prevalent thyroid cancer patients, there is no
debate about the need for current, practical, and evidence-based information on
management. This is especially the case for those with low-risk papillary thyroid
cancer, who represent the vast majority of thyroid cancer patients in the twenty-fi rst
century. In this group, we are learning that “less is more” in terms of the traditional
treatments of surgery and radioiodine and thyroxine-suppressive therapy. On the
other end of the spectrum, patients with more advanced disease are benefi tting from
new targeted therapies with a host of new pharmaceutical agents, as well as local
treatments directed at individual metastatic lesions. In addition, new approaches to
less common forms of thyroid malignancy, including medullary thyroid cancer, ana-
plastic cancer, and lymphoma, are also being developed.
There are textbooks of thyroid disease in general and of thyroid cancer specifi -
cally; they provide the reader with a vast amount of important information related
to etiology, epidemiology, diagnosis, and management. We also know that there is a
vast amount of information now available electronically that provides helpful infor-
mation with the click of a mouse. The object of this text, however, is to provide the
practitioner with clinically relevant information in the context of the classical medi-
cal learning tool, the case history. These illustrative thyroid cancer cases have been
selected to cover the various clinical issues encountered in the care of thyroid cancer
patients. The text begins with cases highlighting the diagnostic diffi culties in
patients with indeterminate thyroid nodules and then provides case histories of
patients with the whole range of differentiated thyroid cancer, including special
circumstances, such as thyroid cancer in children and in pregnancy. Case histories
of patients with advanced thyroid cancer, including those with metastatic disease
receiving high-dose radioiodine and those with radioiodine-refractory disease being
treated with new “targeted therapies,” are also included. All the case histories are
v
vi Preface
written by an international group of authorities in the fi eld of thyroid cancer, and all
recommendations are based on evidence-based clinical practice guidelines and data
from the recent published literature.
We wish to thank all the contributors to the book. They have done what we
asked: to ensure that their case reports were brief, succinct, and current and to pro-
vide guidance in areas of controversy. We also wish to thank Ms. Susan Westendorf
of Springer for her superb assistance and support in the production of the book. We
hope this novel text will provide guidance to those who seek to increase their under-
standing of thyroid cancer management.
Baltimore, MD, USA David S. Cooper, MD
Rome, Italy Cosimo Durante, MD
10-May-2015
Contents
Part I Low Risk Differentiated Thyroid Cancer:
Preoperative Diagnosis
1 A Patient with a Single Thyroid Nodule Suspicious
for Follicular Neoplasm According to the Bethesda System
for Reporting Thyroid Cytopathology: Molecular Evaluation ........... 3
Katie B. Guttenberg and Susan J. Mandel
Part II Low Risk Differentiated Thyroid Cancer: Initial Management:
Extent of Surgery and Use of Radioactive Iodine Therapy
2 A Case of a Small (1–2 cm) Papillary Thyroid Cancer
in a Young Patient: Lobectomy Versus Total Thyroidectomy ............ 19
Gerard M. Doherty
3 The Decision-Making Process for Prophylactic Central Neck
Dissection in a Patient Presenting with an Indeterminate
Thyroid Nodule on Cytology Assessment: Role of Preoperative
Ultrasound and Molecular Marker Testing .......................................... 25
Salem I. Noureldine and Ralph P. Tufano
4 Incidentally Discovered Micropapillary Thyroid Cancer ................... 37
Douglas S. Ross
5 Completion Thyroidectomy in a Patient with Low-Risk
Papillary Cancer ..................................................................................... 45
David S. Cooper
6 A Case of Multifocal Papillary Thyroid Microcarcinoma................... 51
Victor J. Bernet and Ana-Maria Chindris
7 A Papillary Thyroid Cancer with Minimal Extra-thyroidal
Extension .................................................................................................. 61
Donald S. A. McLeod
vii
viii Contents
8 A Case of a Papillary Thyroid Cancer with Lymph Node
Metastases Found on Prophylactic Central Neck Dissection
(Subclinical Disease, Micrometastases) ................................................. 73
Ian D. Hay
9 Papillary Thyroid Cancer with Central Neck Lymph
Node Metastases ...................................................................................... 83
Alyse S. Goldberg , Lorne E. Rotstein , and Anna M. Sawka
10 A Patient with a Large Minimally Invasive Follicular
Thyroid Cancer ....................................................................................... 95
Tracy S. Wang , Paolo Goffredo , and Julie Ann Sosa
11 A Young Patient with Intrathyroidal Papillary Thyroid Cancer
and Family History of Differentiated Thyroid Cancer ........................ 105
Cosimo Durante , Fabiana Trulli , and Sebastiano Filetti
12 A Child with Papillary Thyroid Cancer and Locally
Advanced Disease but No Distant Metastasis ....................................... 111
Sarah J. Bottomley and Steven G. Waguespack
Part III Low Risk Differentiated Thyroid Cancer:
Postoperative Follow-Up
13 A Patient with Papillary Thyroid Cancer and Biochemical
Evidence of Disease at the One-Year Follow-Up Visit ......................... 121
Cosimo Durante and Sebastiano Filetti
14 Low but Detectable Suppressed Thyroglobulin Levels
in the Follow-Up of Differentiated Thyroid Cancer ............................ 127
Fernanda Vaisman
15 A Patient with Papillary Thyroid Carcinoma
and Biochemical Evidence of Disease at Follow-Up Visits
and Increasing Serum Tg Values at the Follow-Up Assessments ....... 135
Yasuhiro Ito and Akira Miyauchi
16 A Young Patient with Recurrent Lymph Node Involvement:
Imaging, Cytology, and Thyroglobulin Washout ................................. 145
Livia Lamartina , Sebastiano Filetti , and Cosimo Durante
Part IV Low Risk Differentiated Thyroid Cancer: Special Issues
17 Papillary Thyroid Carcinoma Diagnosed During Pregnancy ............. 155
Stephanie Lee and David S. Cooper
18 Risks of Thyroid Hormone Suppression for Differentiated
Thyroid Cancer in the Elderly ............................................................... 159
Swaytha Yalamanchi and David Cooper
Contents ix
19 A Patient in Whom One Pathologist Says She Has Cancer,
and Another Says that the Lesion Is Benign ........................................ 167
Justin A. B ishop
20 A Case with Postsurgical Hypoparathyroidism ................................... 175
Jessica Pepe and Salvatore Minisola
21 A Patient with Postsurgical Recurrent Laryngeal
Nerve Damage and Nerve Monitoring .................................................. 185
David L. Steward and Adam D. Goodale
Part V High Risk Differentiated Thyroid Cancer:
The Need for Additional Therapy
22 A Case of Papillary Thyroid Cancer Without Aggressive
Histological Features with Nodal Metastases Detected
During Follow-Up in a Younger Patient ............................................... 197
Maria Grazia Castagna , Lucia Brilli , and Furio Pacini
23 A Case of Papillary Thyroid Cancer Without
Aggressive Histological Features with Nodal Metastases
in an Older Patient .................................................................................. 201
Maria Grazia Castagna , Lucia Brilli , and Furio Pacini
24 A Patient with a Large Hürthle Cell Carcinoma
of the Thyroid and Nodal Metastases .................................................... 207
Leonard Wartofsky
25 A Case of a Large, Invasive PTC with Gross Residual
Disease (pT4) After Surgery .................................................................. 213
Meredith Giuliani and James Brierley
Part VI High Risk Differentiated Thyroid Cancer:
The Use of Radioiodine
26 A Patient with Papillary Carcinoma of the Thyroid
with Elevated Serum Thyroglobulin but Negative
Imaging Studies ....................................................................................... 223
Leonard Wartofsky
27 A Young Child with Papillary Thyroid Cancer
and Metastatic Pulmonary Disease: Role of Radioactive
Iodine Therapy in Children ................................................................... 229
Monica L. Arango and Steven G. Waguespack
28 A Patient with Bone Metastases from Follicular Carcinoma
of the Thyroid .......................................................................................... 237
Leonard Wartofsky
