II. Epidemiology
-
Incidence of Thyroid Carcinoma: 44,000/year (as of 2024, U.S.)
- Three fold increased Incidence in 40 years is a result of greater detection
- Gender: 70% of cases are in women
- Age: Mean onset at 51 years old
- Less common in black patients
-
Incidence by Nodule type
- Single Nodules: 5-10% are carcinoma
- Multinodular Goiter: <5% are carcinoma
III. Types: Thyroid Carcinoma
- Papillary carcinoma (80 to 84%)
- Insidious growth
- May go undiagnosed until metastases
- Follicular Carcinoma (4 to 25%)
- Female > Male
- Peaks at age 50-60 years
-
Medullary Carcinoma (5-10%)
- Secretes multiple substances including Calcitonin
- Associated with Multiple Endocrine Neoplasia
- MEN 2a (Sipple's Syndrome)
- Pheochromocytoma and Parathyroid hyperplasia
- MEN 2b
- Pheochromocytoma and mucosal neuroma
- MEN 2a (Sipple's Syndrome)
- Undifferentiated Carcinoma (5-10%)
- Thyroid Lymphoma (5%)
IV. Risk Factors (and Red Flags)
- Male gender (especially under age 40 years)
- Age extremes (under age 20 and over age 65)
- Rapid painless growth of Thyroid Nodule
- Local symptoms consistent with invasion
- Dysphagia
- Neck Pain
- Hoarseness or raspy voice
- Head and neck radiation history
-
Family History of Thyroid malignancy
- Thyroid Cancer
- Thyroid polyposis (Gardner's Syndrome)
- Thyroid fixation to skin or trachea
- Hard Nodule on palpation
V. Evaluation
- See Thyroid Nodule
- Most Thyroid Cancers are asymptomatic (found incidentally on imaging, or palpated on exam)
VI. Management: Thyroid Cancer
- Unilateral microcarcinomas (=1 cm or up to 1.5 cm)
- Consider observation without surgical resection
- Tumors >1 cm with or without Lymph Node metastases
- Surgery with or without Radioactive Iodine
- Treatment is curative in most cases of well-differentiated Thyroid Cancer
- Recurrent local or regional disease
- Surgical resection
- Metastatic Thyroid Cancer
- Surgical resection or stereotactic body irradiation
- Advanced Thyroid Cancer AND genetic mutations (BRAF, RET, NTRK, MEK)
- Dabrafenib
- Selpercatinib
- Thyroid Cancer not responding to Radioactive Iodine
- Antiangiogenic multikinase inhibitors (eg, Sorafenib, Lenvatinib, Cabozantinib)
- Radioactive Iodine response varies by genetic mutation
- RAS Mutations respond to Radioactive Iodine
- BRAF V600E mutations tend not to respond to Radioactive Iodine
VII. Management: Cancer Survivor Care
- See Cancer Survivor
- Follicular, Hurtle Cell or Papillary Cancer
- Visits (history, exam, labs) at 6 and 12 months, then yearly
- Labs at 6 and 12 months, then yearly
- Thyroid Stimulating Hormone (TSH)
- Thyroglobulin Antibody
- Thyroglobulin
- Ultrasensiitive Thyroglobulin if treated with Radioactive Iodine
- Imaging
- Neck Ultrasound every 6 months for 1 to 2 years, then yearly
- TSH stimulated whole body Radioiodine imaging if high risk for metastatic disease
-
Medullary Cancer
- Serum Calcitonin every 6 to 12 months
- Carcinoembryonic Antigen (CEA Antigen) every 6 to 12 months
- Additional testing for Multiple Endocrine Neoplasia 2A or 2B
- Urine or plasma metanephrine yearly
- Plasma Parathyroid Hormone test yearly
- References
VIII. Prognosis
- Overall 5 year survival: 98%
- Papillary carcinoma has the best prognosis of Thyroid Cancer
- Medullary Carcinoma and Follicular Carcinoma have a more variable prognosis
- Undifferentiated Thyroid Cancer and anaplastic Thyroid Cancer have a worse prognosis
IX. References
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Related Studies
| Definition (NCI) | A benign or malignant neoplasm affecting the thyroid gland. |
| Definition (MSH) | Tumors or cancer of the THYROID GLAND. |
| Definition (CSP) | new abnormal thyroid tissue that grows by excessive cellular division and proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease. |
| Concepts | Neoplastic Process (T191) |
| MSH | D013964 |
| SnomedCT | 127018007 |
| English | Neoplasm, Thyroid, Neoplasms, Thyroid, Thyroid Neoplasms, Thyroid Gland Neoplasm, NEOPL THYROID, THYROID NEOPL, neoplasm of thyroid gland, neoplasm of thyroid gland (diagnosis), neoplasm located in the thyroid gland, Thryoid neoplasia, Thyroid neoplasia, Neoplasm thyroid, Thyroid neoplasm NOS, Thyroid neoplasms, Thyroid Neoplasms [Disease/Finding], Thyroid Neoplasm, thyroid gland tumor, thyroid tumour, gland thyroid tumors, neoplasm thyroid, thyroid neoplasms, thyroid tumor, tumor thyroid, gland neoplasms thyroid, neoplasms thyroid, thyroid tumours, tumor thyroid gland, gland thyroid tumours, thyroid tumors, thyroid neoplasm, thyroid neoplasm location: thyroid gland, thyroid neoplasm location: thyroid gland (diagnosis), Thyroid gland--Tumors, Thyroid neoplasm, Thyroid tumor, Thyroid tumour, Tumor of thyroid gland, Tumour of thyroid gland, Neoplasm of thyroid gland (disorder), Neoplasm of thyroid gland, Neoplasm of Thyroid Gland, Neoplasm of Thyroid, Neoplasm of the Thyroid Gland, Neoplasm of the Thyroid, Thyroid Gland Tumor, Thyroid Tumor, Tumor of Thyroid Gland, Tumor of Thyroid, Tumor of the Thyroid Gland, Tumor of the Thyroid |
| Italian | Tumore della tiroide, Tumori della tiroide, Neoplasia della tiroide, Tumore della tiroide NAS, Neoplasia tiroidea, Neoplasie della tiroide |
| Dutch | neoplasma thyroïd, thryoïdneoplasie, thyroïdneoplasie, schildklierneoplasma NAO, schildkliertumor, schildklierneoplasmata, thyroïdneoplasma, Schildkliertumor, Schildkliertumoren, Tumor, schildklier-, Tumoren, schildklier- |
| French | Tumeur de la thyroïde SAI, Néoplasie thyroïdienne, Tumeur de la thyroïde, Tumeur thyroïdienne, Tumeurs de la thyroïde, Tumeurs thyroïdiennes |
| German | Schilddruesenneoplasie, Neubildung der Schilddruese NNB, Neubildung Schilddruese, Schilddruesentumor, Neubildung der Schilddruese, Neubildungen der Schilddruese, Neubildungen, Thyreoidea-, Schilddrüsentumoren |
| Portuguese | Neoplasia da tiroideia NE, Neoplasia da tiroideia, Neoplasias da Glândula Tireoide, Câncer da Glândula Tireoide, Neoplasias da tiroideia, Tumor da tireóide |
| Spanish | Neoplasia de tiroides NEOM, Neoplasia tiroidea, Tumor tiroideo, neoplasia de la glándula tiroides (trastorno), neoplasia de la glándula tiroides, Neoplasias tiroideas, Neoplasia de tiroides, Neoplasias de la Tiroides |
| Japanese | 甲状腺の新生物, ｺｳｼﾞｮｳｾﾝｼﾝｾｲﾌﾞﾂ, ｺｳｼﾞｮｳｾﾝﾉｼﾝｾｲﾌﾞﾂ, 甲状腺新生物ＮＯＳ, ｺｳｼﾞｮｳｾﾝｼｭﾖｳ, ｺｳｼﾞｮｳｾﾝｼﾝｾｲﾌﾞﾂNOS, 甲状腺新生物, 甲状腺腫瘍 |
| Swedish | Sköldkörteltumörer |
| Finnish | Kilpirauhasen kasvaimet |
| Russian | RAK SHCHITOVIDNOI ZHELEZY, SHCHITOVIDNOI ZHELEZY RAK, SHCHITOVIDNOI ZHELEZY NOVOOBRAZOVANIIA, РАК ЩИТОВИДНОЙ ЖЕЛЕЗЫ, ЩИТОВИДНОЙ ЖЕЛЕЗЫ НОВООБРАЗОВАНИЯ, ЩИТОВИДНОЙ ЖЕЛЕЗЫ РАК |
| Czech | Neoplasma štítnice, Nádory štítné žlázy, Novotvar štítné žlázy, Novotvar štítné žlázy NOS, Nádor štítné žlázy, thyreoidea - nádory, nádory štítné žlázy, tyreoidea - nádory |
| Croatian | TIREOIDNI TUMORI, TIROIDNI TUMORI, TUMORI ŠTITNJAČE |
| Polish | Nowotwory tarczycy |
| Hungarian | Pajzsmirigy neoplasia, Pajzsmirigy neoplasia k.m.n., Pajzsmirigydaganat, Pajzsmirigy-daganat, Pajzsmirigy neoplasmák, Thyreoid daganat, Pajzsmirigytumor |
| Norwegian | Svulster i skjoldbruskkjertelen, Skjoldbruskkjertelsvulster, Skjoldbruskkjertelneoplasmer, Tyreoideaneoplasmer, Tyreoideasvulster, Neoplasmer i skjoldbruskkjertelen |
Ontology: Thyroid carcinoma (C0549473)
| Definition (MEDLINEPLUS) |
Your thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It makes hormones that help the body work normally. There are several types of cancer of the thyroid gland. You are at greater risk if you
You should see a doctor if you have a lump or swelling in your neck. Doctors use a physical exam, blood tests, imaging tests, and a biopsy to diagnose thyroid cancer. Treatment depends on the type of cancer you have and how far the cancer has spread. Many patients receive a combination of treatments. They may include surgery, radioactive iodine, hormone treatment, radiation therapy, chemotherapy, or targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells. NIH: National Cancer Institute |
| Definition (NCI) | A carcinoma arising from the thyroid gland. It is usually an adenocarcinoma and includes the following main subtypes: follicular, papillary, medullary, poorly differentiated, and anaplastic. |
| Definition (NCI_NCI-GLOSS) | Cancer that forms in the thyroid gland (an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight). Four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic thyroid cancer. The four types are based on how the cancer cells look under a microscope. |
| Concepts | Neoplastic Process (T191) |
| MSH | D013964 |
| English | THYROID CARCINOMA, Thyroid Gland Carcinoma, Thyroid carcinoma NOS, Carcinoma thyroid, Thyroid cancer, thyroid cancer (diagnosis), thyroid cancer, Cancer of Thyroid, Cancer of the Thyroid, Cancers, Thyroid, Thyroid Cancer, Thyroid Cancers, Cancer of thyroid, Thyroid Gland Cancer, carcinoma thyroid gland, thyroid gland carcinoma, Carcinoma;thyroid gland, carcinoma thyroid, carcinoma of thyroid, thyroid ca, Cancer, Thyroid, Thyroid gland--Cancer, Thyroid cancer, NOS, thyroid carcinoma, carcinoma of thyroid gland, thyroid carcinoma (diagnosis), Thyroid Carcinomas, Carcinomas, Thyroid, Thyroid carcinoma, Head and Neck Cancer, Thyroid, Carcinoma of Thyroid Gland, Carcinoma of Thyroid, Carcinoma of the Thyroid Gland, Carcinoma of the Thyroid, Thyroid Carcinoma, Carcinoma, Thyroid, carcinoma of the thyroid gland |
| Dutch | thyroïdcarcinoom, schildkliercarcinoom NAO, schildklierkanker, carcinoom thyroïd, Schildklierkanker, Tumor van de schildklier |
| French | Carcinome thyroïdien, Carcinome de la thyroïde, Carcinome de la thyroïde SAI, Cancer de la thyroïde, CANCER DE LA THYROIDE, Cancer thyroïdien, Tumeur maligne de la thyroïde, Tumeur maligne thyroïdienne |
| German | Schilddruesenkarzinom NNB, Schilddruesenkarzinom, Schilddruesenkrebs, Karzinom der Schilddruese, Krebs der Schilddrüse, Schilddrüsenkrebs |
| Italian | Carcinoma della tiroide NAS, Cancro della tiroide, Carcinoma della tiroide |
| Portuguese | Carcinoma da tiroideia, Cancro da tireóide, Carcinoma da tiroideia NE, CARCINOMA DA TIROIDE, Câncer de Tireoide, Câncer da Tireoide |
| Spanish | Cáncer de tiroides, Carcinoma de tiroides, Carcinoma de tiroides NEOM, Cáncer de Tiroides, Cáncer Tiroideo |
| Japanese | 甲状腺癌ＮＯＳ, 甲状腺癌, ｺｳｼﾞｮｳｾﾝｶﾞﾝNOS, ｺｳｼﾞｮｳｾﾝｶﾞﾝ |
| Czech | Rakovina štítné žlázy, Karcinom štítné žlázy NOS, Karcinom štítné žlázy, karcinom štítné žlázy, tyreoidea - karcinom, rakovina štítné žlázy, štítná žláza - karcinom |
| Hungarian | Pajzsmirigy rák, Pajzsmirigy-carcinoma, Pajzsmirigy carcinomája, Pajzsmirigy-carcinoma k.m.n. |
| Norwegian | Kreft i skjoldbruskkjertelen, Skjoldbruskkjertelkreft, Tyreoideakreft |
