II. Epidemiology
- Incidence of Thyroid Carcinoma US: 20,000/year
-
Incidence by Nodule type
- Single Nodules: 5-10% are carcinoma
- Multinodular Goiter: <5% are carcinoma
III. Types: Thyroid Carcinoma
- Papillary carcinoma (up to 80%)
- Insidious growth
- May go undiagnosed until metastases
- Follicular Carcinoma (10-25%)
- Female > Male
- Peaks at age 50-60 years
-
Medullary Carcinoma (5-10%)
- Secretes multiple substances including Calcitonin
- Associated with Multiple Endocrine Neoplasia
- MEN IIa (Sipple's Syndrome)
- Pheochromocytoma and Parathyroid hyperplasia
- MEN IIb
- Pheochromocytoma and mucosal neuroma
- MEN IIa (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
VI. Prognosis
- Papillary carcinoma
- Best prognosis of Thyroid Cancer
- Ten year survival: 70-80%
- Follicular Carcinoma
- Five year survival: 30%
-
Medullary Carcinoma
- Variable prognosis