AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 14

Thyroid Cancer

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Thyroid Nodules and Cancer Thyroid cancer and the management of thyroid masses can be a confusing topic of discussion. Thyroid nodules are singular or multiple,

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often encapsulated, growths found in the thyroid gland (Figure 14.1). They are most frequently benign and so common, particularly with advancing age, as to preclude biopsy and removal in every patient who presents with nodules. However, otolaryngologists often recommend and perform removal of nodules that have a reasonable risk of being cancerous, as determined by multiple factors that include those discussed below. Risk factors for malignant thyroid nodules are based on gender, age, early radiation exposure, and a family history of thyroid cancer. While thyroid nodules are much more common in women than in men, a nodule in a male has a higher risk of being cancerous than a nodule in a

Figure 14.1. Large neck mass eccentrically located in the right neck.

female. Older people also develop more benign nodules than younger people (i.e., a nodule in a person younger than 40 years old has a higher chance of being cancerous than a nodule in a person older than 40). In addition, larger nodules and nodules that demonstrate growth are more commonly malignant. Approximately 2 percent of children have palpable thyroid nodules and, while most thyroid nodules in children are benign, the percentage of nodules harboring cancer in children is higher than in adults. Thyroid cancer in children is often associated with radiation exposure, or a genetic syndrome, such as multiple endocrine neoplasia (MEN). The standard accepted and effective method for determination of the contents of a thyroid mass or nodules is fine-needle aspiration biopsy

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