Thyroid Cancer: A Case-Based Approach

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Now in its second edition utilizing brand new clinical case material, this popular, user-friendly text presents the diagnosis and treatment of thyroid cancer and related clinical issues, providing clinicians in endocrinology and oncology with the best real-world strategies to properly manage the various manifestations of thyroid cancer that they may encounter. Each chapter is a case report that opens with a unique clinical presentation, followed by a description of the diagnosis, assessment and therapy, as well as the case outcome, literature review, clinical pearls and pitfalls, and bibliography. All recommendations are based on evidence-based clinical practice guidelines and recent literature. 

Written by experts in the field, these cases illustrate treatment for both low- and high-risk differentiated thyroid cancer, including surgical approaches, radioiodine therapy, and novel chemotherapies and targeted therapies, as well as postoperative follow-up and special issues. Additional cases demonstrate the management of medullary thyroid cancer and anaplastic thyroid cancer. Topics new to the second edition include information on management of small thyroid cancers with “active surveillance” (without surgery), new chemotherapeutic approaches to advanced thyroid cancer, and new information on a lesion that is no longer considered to be thyroid cancer (Neoplastic Follicular Thyroid Neoplasm with Papillary-Like Features [NIFTP]), as well as material on external beam radiotherapy and new approaches to the management of anaplastic thyroid cancer.

Pragmatic and reader-friendly, this second edition of Thyroid Cancer: A Case-Based Approach will be an excellent resource for clinical endocrinologists and oncologists, endocrine fellows, residents and students alike.

Author(s): Giorgio Grani, David S. Cooper, Cosimo Durante
Edition: 2
Publisher: Springer
Year: 2021

Language: English
Pages: 403
City: Cham

Preface to the Second Edition
Contents
Contributors
Part I: Differentiated Thyroid Cancer: Initial Management
Chapter 1: A Patient with a Single Thyroid Nodule Suspicious for Follicular Neoplasm According to the Bethesda System for Reporting Thyroid Cytopathology: Molecular Evaluation
Case Presentation
Assessment and Literature Review
Part I: Risk of Malignancy
Limitations of Cytologic and Histologic Interpretations
Demographic and Sonographic Features Predictive of Malignancy
Part II: Molecular Evaluation
Part III: Surgical Management
Management of the Case
References
Chapter 2: A Young Patient with Intrathyroidal Papillary Thyroid Cancer and Family History of Differentiated Thyroid Cancer
Case Presentation
Literature Review
Back to the Patient
References
Chapter 3: A Case of a Small (1–2 cm) Papillary Thyroid Cancer in a Young Patient: Lobectomy Versus Total Thyroidectomy
Case Presentation
Assessment and Literature Review
Prognostic Features
Management Strategies
Complications of Total Thyroidectomy
Indications for Adjuvant Radioiodine Therapy
Management of the Case
References
Chapter 4: A Patient with Papillary Microcarcinoma Undergoing Active Surveillance
Case Presentation
Literature Review
Tailoring the Management Approach
Molecular Markers
Long-Term Planning and Communication with the Patients
Back to the Patient
References
Chapter 5: Completion Thyroidectomy in a Patient with Low-Risk Papillary Cancer
The Case
Assessment and Literature Review
Back to the Patient
References
Chapter 6: Papillary Thyroid Cancer with Microscopic Extra-thyroidal Extension
Case Presentation
Assessment and Literature Review
Definition and Prevalence
Comparison of Microscopic with Major Extra-thyroidal Extension
Survival with Microscopic Extra-thyroidal Extension
Recurrence Risk with Microscopic Extra-thyroidal Extension
Management of the Case
Was Completion Thyroidectomy Required?
Is a Postoperative Thyroglobulin Useful in Determining Further Treatment?
Will Radioiodine Remnant Ablation Be Helpful?
What Should the Thyrotropin (TSH) Target Be?
Would Molecular Testing of Our Patient’s Thyroid Cancer Assist in Decision-Making?
Case Progress
References
Chapter 7: A Small Papillary Thyroid Cancer with Angioinvasion
Introduction
Case Presentation (Diagnosis and Investigation)
Literature Review
Case Summary
References
Chapter 8: A Patient with a Pathological Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP)
Case Presentation
Literature Review
Back to the Patient
References
Chapter 9: Papillary Thyroid Cancer with Central Neck Lymph Node Metastases
Case Presentation
Diagnosis/Assessment
Literature Review
Classification of Lymph Node Disease
Epidemiology of N1 Disease in Patients with PMC
Prognosis of N1 Disease in Patients with PMC
Does RAI Adjuvant Treatment Reduce the Risk of Disease Recurrence in T1aN1 Disease?
Management Considerations and Outcomes
References
Chapter 10: A Patient with a Large Minimally Invasive Follicular Thyroid Cancer
Case Presentation
Epidemiology
Staging
Histology
Molecular Characteristics of FTC
miFTC
Treatment of miFTC
Lymph Node and Distant Metastases in miFTC
Molecular Characteristics of miFTC
Back to the Case
References
Chapter 11: An Adolescent with Papillary Thyroid Carcinoma and Locally Metastatic Disease but No Distant Metastases
Introduction
Case Presentation
Assessment and Literature Review
Back to the Case
References
Part II: Differentiated Thyroid Cancer: Postoperative Follow-Up
Chapter 12: A Patient with Papillary Thyroid Cancer and Biochemical Evidence of Possible Residual Disease at the One-Year Follow-Up Visit
Case Presentation
Literature Review
What Is the Role of Serum Tg Measurement in Patients Who Have Not Undergone Radioiodine Remnant Ablation?
What Is the Role of Neck US or Other Imaging Techniques?
What Are the Criteria for the Absence of Persistent Tumor?
Back to the Patient
References
Chapter 13: A Patient with Low-Risk Papillary Thyroid Cancer Who Has Undergone a Lobectomy: Monitoring for Recurrent Disease and Assessment of Thyroid Function
Clinical Case Presentation
Assessment and Literature Review
Back to the Patient
References
Chapter 14: A Patient with Papillary Thyroid Carcinoma and Biochemical Evidence of Disease at Follow-Up Visits and Increasing Serum Tg Values at Follow-Up Assessments
Case Presentation
Assessment and Literature Review
Therapies for Metastatic PTC
Representative Molecular-Targeted Agents for RAI-Refractory PTC
Prognosis of DTC Patients with RAI-Refractory Metastases
Thyroglobulin-Doubling Time
Tumor-Doubling Time
Management of the Case
Initial Management After Surgery
Management After Detection of RAI-Refractory Recurrences
References
Chapter 15: A Young Patient with Recurrent Lymph Node Involvement: Imaging, Cytology, and Thyroglobulin Washout
Case Presentation
Literature Review
Back to the Patient
References
Part III: Differentiated Thyroid Cancer: Special Issues
Chapter 16: Papillary Thyroid Carcinoma Diagnosed During Pregnancy
Case Presentation
Assessment and Literature Review
Back to the Patient
References
Chapter 17: Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly
Case Presentation
Assessment and Literature Review
Prevalence
Efficacy of Thyroid Hormone Suppression Therapy
Recommendations for Serum TSH Suppression Goals
Adverse Effects Associated with Suppressive T4 Therapy in the Elderly
Cardiovascular Disease
Dysrhythmias
Cardiovascular Mortality
Bone Mineral Density and Fracture Risk
Treatment
Management of the Patient
References
Chapter 18: A Case with Postsurgical Hypoparathyroidism: Treatment Options
Case Presentation
Assessment and Literature Review
Definition and Prevalence
Predictors of Post-thyroidectomy Hypocalcemia
Therapy
Long-Term Follow-Up
Management of the Case
References
Chapter 19: A Patient with Postsurgical Recurrent Laryngeal Nerve Damage and Nerve Monitoring
Case Presentation
Assessment and Literature Review
Mechanism of Nerve Injury
Evaluating Recurrent Laryngeal Nerve Function Intraoperatively
Clinical Manifestations
Management
Voice and Swallowing Therapy
Surgical Management
Back to the Patient: Outcome
References
Part IV: Differentiated Thyroid Cancer: Managing higher risk patients
Chapter 20: A Case of Papillary Thyroid Cancer Without Aggressive Histological Features with a Nodal Metastasis Detected During Follow-Up in a Young Patient
The Case
Assessment and Literature Review
Back to the Patient
References
Chapter 21: A Patient with a Large Hürthle Cell Carcinoma of the Thyroid and Nodal Metastases
Case
Hürthle Cell Carcinoma: Literature Review
Management of the Patient
References
Chapter 22: A Case of a Large, Invasive PTC with Gross Residual Disease (pT4) After Surgery
Case Presentation
Literature Review
Management of the Patient
References
Chapter 23: A Patient with Papillary Carcinoma of the Thyroid with Elevated Serum Thyroglobulin but Negative Imaging Studies
Case
Assessment
Relevant Literature
Back to the Case
References
Chapter 24: A Child with Papillary Thyroid Cancer and Metastatic Pulmonary Disease: Role of Radioactive Iodine Therapy
Introduction
Case Presentation
Assessment and Literature Review
Back to the Case
References
Chapter 25: A Patient with Bone Metastases from Follicular Carcinoma of the Thyroid
Case
Assessment
Relevant Literature
Subsequent Management
References
Chapter 26: Radioiodine Therapy in Lactating Women with Higher-Risk Differentiated Thyroid Cancer
Case Presentation
Assessment and Literature Review
Definitions/Background
Radioiodine Ablation
Relative and Absolute Contraindications to RAI Therapy
Prevalence
Pathophysiology
Role of Prolactin
Medical Therapy
Management of the Case
References
Part V: Differentiated Thyroid Cancer: Beyond Radioactive Iodine Therapy
Chapter 27: A Case of a Patient with RAI-Refractory Differentiated Thyroid Cancer with Progressive Neck Disease and Stable Lung Metastases
Case Presentation
Workup/Diagnosis
Management
Conclusions
References
Chapter 28: A Case of Fistula After Adjuvant External Beam Radiotherapy and Lenvatinib for High-Risk Follicular Thyroid Cancer
Initial Presentation
Surgical Resection and Pathologic Findings
Consideration of Adjuvant Radiation Treatment in High-Risk Follicular Thyroid Cancer
Considerations in Radiation Planning: Balancing Local Control and Toxicity
Patient Outcome with Radiation Treatment: Side Effects and Locoregional Control
Initiation of Systemic Therapy for Locally Advanced or Metastatic Thyroid Cancer
Development of Tracheoesophageal Fistularization and Associated Risk Factors
Conclusion and Future Directions
References
Chapter 29: RAI Refractory Differentiated Thyroid Cancer with Multiple-Organ Progressive Disease
Case Presentation
Literature Review
Management of the Case
References
Chapter 30: RAI-Refractory Differentiated Thyroid Cancer and Lung Lesions Causing Bleeding
Case Presentation
Literature Review
Management of the Case
References
Chapter 31: A Patient with Follicular Thyroid Cancer and a Painful Bone Metastases at Risk for Pathologic Fracture
Case Presentation
Assessment and Literature Review
Characteristics of Bone Lesions from Differentiated Thyroid Cancer
Treating Bone Metastases with Radioactive Iodine
Indications and Options of Local Treatment
Principles and Definition of External Beam Radiation Therapy
Principles and Definition of Thermal Ablation
Thermal Ablation for Treatment of Bone Metastases
Thermal Ablation on Metastatic Sites Other Than Bone
Denosumab and Bisphosphonates
Management of the Case
Radioactive Iodine Treatment
Cryoablation and Cementoplasty
References
Chapter 32: Differentiated Thyroid Cancer and Brain Metastases
Case Presentation
Literature Review
Management of the Case
References
Chapter 33: RAI-Refractory, Advanced Differentiated Thyroid Cancer Receiving Kinase Inhibitor Treatment: Checking for Drug-Drug Interactions
Case Presentation
Literature Review
Management of the Case
References
Part VI: Medullary Thyroid Cancer
Chapter 34: Management of Postoperative Hypercalcitoninemia in Medullary Thyroid Carcinoma
Case Presentation
Assessment and Literature Review
Postoperative Staging of MTC Patients
Prognosis of Postoperative Patients
Treatment
Initial Surgical Approach to Patients with Clinically Apparent MTC
Surgical Approach to Patients with Persistent or Recurrent MTC
Role of Somatic RET Mutation Testing in Selection of Patients for Targeted Oral Chemotherapy
Management of the Case
References
Chapter 35: Tumor Related- and Non-tumor-Related Diarrhea in a Medullary Thyroid Cancer Patient
Case Presentation
Diarrhea in MTC
Management of Diarrhea in MTC
Diarrhea as an Adverse Event of Novel Targeted Agents in MTC
Back to the Patient
Symptomatic Management of the Case
Bibliography
Chapter 36: Clinical Management of a Patient with a Locally Recurrent Medullary Thyroid Cancer and Asymptomatic Slowly Progressing Distant Metastases
Case Presentation
Diagnosis/Assessment
Management
Outcome
Conclusions
References
Chapter 37: A Patient with an Advanced Medullary Thyroid Cancer and Progressive, Symptomatic Distant Metastases: When to Start Systemic Therapy
Case Presentation
Diagnosis/Assessment
Management
Outcome
Conclusions
References
Chapter 38: Medical Treatment Decision-Making for Advanced Medullary Thyroid Cancer
Introduction
Case 1: Active Surveillance
Active Surveillance for Progressive Disease
Integration of Local Therapies into the Management of Progressive or Symptomatic Focal Metastases
Case 2: Treating with a Systemic Agent and Management of Adverse Effects
Approved Agents for MTC: Cabozantinib, Vandetanib, and Selpercatinib
Adverse Events Associated with Approved Agents
Choosing a Therapeutic Agent Based on Adverse Event Risk Rather than Efficacy
References
Chapter 39: Screening Leading to Diagnosis of C cell Hyperplasia
Introduction
Case Presentation
Case Discussion
References
Chapter 40: Increased Basal Calcitonin in Nodular Goiter: Is It Micromedullary Thyroid Cancer?
Case Presentation
Evaluation for Surgery
Assessment and Literature Review
Is It Medullary Thyroid Cancer?
If It Is Medullary Thyroid Cancer, Will It Be Confined to the Thyroid Gland?
If Basal Calcitonin Fails to Normalize, Will Reoperation Be Worthwhile for Minimal Disease?
Management of the Case
Importance of Identifying Occult Medullary Thyroid Cancer
References
Chapter 41: Timing and Extent of Surgery for a Pediatric Patient with Hereditary MTC and Positive Screening for the p.S891A RET Mutation
Case Presentation
Evaluation for Surgery
Assessment and Literature Review
Management of the Cases
Outcome
References
Part VII: Anaplastic Thyroid Cancer
Chapter 42: Anaplastic Thyroid Cancer: Surgery or Not in Locally Advanced Disease
Introduction
Case Report
Literature Review
Summary
Back to the Patient
References
Chapter 43: A Patient with BRAFV600E-Mutated Anaplastic Thyroid Cancer with Metastatic Disease
Case Presentation
Assessment and Literature Review
References
Index