endocrine and metabolic disorders
Thyroid Cancers
Papillary Thyroid Carcinoma
Papillary carcinoma accounts for 80 to 90% of all thyroid cancers. The female:male ratio is 3:1. It may be familial in up to 5% of patients. Most patients present between ages 30 and 60. The tumor is often more aggressive in older patients. Many papillary carcinomas contain Follicular Thyroid Carcinoma . One variant is called noninvasive follicular thyroid neoplasm with papillary-like nuclear features (previously known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma) and is considered to be a benign lesion ( The incidence of papillary thyroid carcinoma has risen over the last several decades, primarily due to the incidental discovery of small cancers in patients undergoing neck ultrasonography, MRI, CT scans, or PET scans that include the neck in the imaging field. The tumor spreads via lymphatics to regional lymph nodes in one third of patients and may metastasize to the lungs. Patients<55 years with small tumors confined to the thyroid have an excellent prognosis. Tumors>4 cm or that are diffusely spreading require total or near-total thyroidectomy with postoperative radioiodine ablation of residual thyroid tissue with appropriately large doses of iodine-131 administered when the patient is hypothyroid or after recombinant thyroid-stimulating hormone (TSH) injections. Treatment may be repeated after 6 to 12 months to ablate any remaining thyroid tissue. TSH-suppressive doses oflevothyroxineare given after treatment, and serum thyroglobulin levels are measured to help detect recurrent or persistent disease. Neck ultrasonography will detect recurrence in lymph nodes. About 20 to 30% of patients, mainly older patients, have recurrent or persistent disease. 1.5 cm with no evidence of lymph node or distant metastases ( Papillary thyroid carcinoma reference ). 1.Nikiforov YE, Seethala RR, Tallini G, et al: Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: A paradigm shift to reduce overtreatment of indolent tumors.JAMA Oncol2(8):1023–1029, 2016. doi:10.1001/jamaoncol.2016.0386 2.Saravana-Bawan B, Amandeep Bajwa A, Paterson J, et al: Active surveillance of low-risk papillary thyroid cancer: A meta-analysis.Surgery167:46–55, 2020. doi: 10.1016/j.surg.2019.03.040 