AAO-HNSF Primary Care Otolaryngology Handbook

THYROID CANCER

parathyroid glands should be removed, but a total thyroidectomy is always indicated. Thyroid C-cells do not absorb radioactive iodine, so this common modality of adjuvant treatment in well-differentiated thyroid cancers is seldom effective. Anaplastic Carcinoma Anaplastic thyroid cancer is a rare, aggressive cancer with a very poor prognosis. The role of the surgeon is often limited to establishing diag- nosis through open biopsy and securing the airway, which usually involves a tracheotomy. These tumors are rarely resectable and are often treated with external beam radiation and systemic chemotherapy, since 50 percent of patients will have pulmonary metastases at the time of diagnosis. Lymphoma Thyroid lymphoma is a rapidly growing tumor, which frequently compromises the airway and clinically resembles anaplastic carcinoma. Lymphomas may arise in patients with a background of Hashimoto’s thyroiditis, an autoimmune condition characterized by lymphocytic infiltration, but that is a very uncommon correlation. Thyroid lymphomas are most commonly B-cell. A rapid diagnosis and institution of appropriate therapy are necessary to prevent airway obstruction. Treatment and cure are usually achieved by using a combination of chemotherapy and radiation. This brief discussion on thyroid cancer does not include a discourse on surgery of the thyroid gland. This would include such subjects as surgery for hyperthyroidism, which can occur with a toxic nodular goiter and Graves’ disease. These conditions can also be treated medically using radioactive iodine-131, but further discussion is beyond the scope of this book.

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