Surgery and radiation therapy have been the major treatments for<unk>  thyroid carcinoma. A plasma level of metanephrines should be checked before surgical thyroidectomy takes place to evaluate for the presence of pheochromocytoma since 25% of people found to have<unk>  have the inherited form from the MEN2A syndrome. Undiagnosed pheochromocytoma leads to a very high intraoperative risk of hypertensive crisis and, potentially, death. Surgery A surgery for<unk>  showing the central lymph nodes and thyroid gland removed A total thyroidectomy with bilateral neck dissection is the gold standard for treating<unk> , and is the most definitive means of achieving a cure in patients without distant metastases or extensive nodal involvement. Risks of surgery include loss of vocal control, irreparable nerve damage, death or the need for second operation to clean out residual diseased lymph nodes left behind if the sentinel node biopsy was positive for cancerous spread. Extensive surgery can be effective when the condition is detected early, but a risk for recurrence remains, particularly in patients with multiple positive lymph nodes or extracapsular invasion. About half of patients have metastasis to regional lymph nodes at the time of diagnosis. The European Society of Endocrine Surgeons has published recommendations for managing this condition in gene carriers. The timing of surgery depends on the type of mutation present. For those in the highest risk group, surgery is recommended in the first year of life. In lower risk cases surgery may be delayed up to the age of ten years, the precise timing depending on the mutation and other factors. Radiation External beam radiotherapy is recommended when there is a high risk of regional recurrence, even after optimum surgical treatment. In this study, patients treated with external beam radiation were compared to a control group. Disease control with radiation was far superior in the group receiving radiation. The authors of the study 14 wrote: "in 40 high risk patients (microscopic residual disease, extraglandular invasion, or lymph node involvement), the local/regional relapse free rate was 86% at 10 years with postoperative external beam radiation (25 patients), and 52% for those with no postoperative external radiation (p = 0.049). To optimize local/regional tumor control, we therefore continue to advise external beam radiation in patients at high risk of local/regional relapse." Unlike other differentiated thyroid carcinoma, there is no role for radioiodine treatment in<unk> -type disease. Protein kinase inhibitors Clinical trials of protein kinase inhibitors, which block the abnormal kinase proteins involved in the development and growth of<unk>  cancer cells, showed clear evidence of response in 10-30% of patients. In the majority of responders there has been less than a 30% decrease in tumor mass, yet the responses have been durable; responses have been stable for periods exceeding 3 years. The major side effects of this class of drug include hypertension, nausea, diarrhea, some cardiac electrical abnormalities, and thrombotic or bleeding episodes. Vandetanib, trade name Caprelsa, was the first drug (April 2011) to be approved by US Food and Drug Administration (FDA) for treatment of late-stage (metastatic)<unk>  in adult patients who are ineligible for surgery. Cabozantinib, trade name Cometriq, was granted marketing approval (November 2012) by the U.S. FDA for this indication. Cabozantinib which is a potent inhibitor of RET, MET and VEGF was evaluated in a double-blind placebo controlled trial. It was shown to improve overall survival by 5 months for the treated cohort vs. placebo, which was not statistically significant. However, cabozantinib was particularly effective in patients with the RET M918T mutation, extending overall survival by roughly 2 years, doubling survival vs. untreated patient (4 years vs. 2 year). Treatment with cabozantinib did require many dose reduction to mitigate side effects. It has been suggested that the trial dose of 140 mg was excessive, particularly in lower body mass patients. Ongoing trials have been scheduled to identify more optimal dosing regimes. Activity has been observed, in practice at doses of 1.2 mg/kg.
Medullary thyroid cancer
Papillary thyroid cancer
Follicular thyroid cancer
Thyroid lymphoma
Thyroid adenoma
Anaplastic thyroid cancer
Thyroid cancer
Squamous-cell thyroid carcinoma