II. Epidemiology

  1. Incidence of Thyroid Carcinoma US: 20,000/year
  2. Incidence by Nodule type
    1. Single Nodules: 5-10% are carcinoma
    2. Multinodular Goiter: <5% are carcinoma

III. Types of Thyroid Carcinoma

  1. Papillary carcinoma (up to 80%)
    1. Insidious growth
    2. May go undiagnosed until metastases
  2. Follicular Carcinoma (10-25%)
    1. Female > Male
    2. Peaks at age 50-60 years
  3. Medullary Carcinoma (5-10%)
    1. Secretes multiple substances including Calcitonin
    2. Associated with Multiple Endocrine Neoplasia
      1. MEN IIa (Sipple's Syndrome)
        1. Pheochromocytoma and Parathyroid hyperplasia
      2. MEN IIb
        1. Pheochromocytoma and mucosal neuroma
  4. Undifferentiated Carcinoma (5-10%)
  5. Thyroid Lymphoma (5%)

IV. Risk Factors and Red Flags

  1. Male gender (especially under age 40 years)
  2. Age extremes (under age 20 and over age 65)
  3. Rapid painless growth of Thyroid Nodule
  4. Local symptoms consistent with invasion
    1. Dysphagia
    2. Neck Pain
    3. Hoarseness or raspy voice
  5. Head and neck radiation history
  6. Family History of Thyroid malignancy
    1. Thyroid Cancer
    2. Thyroid polyposis (Gardner's Syndrome)
  7. Thyroid fixation to skin or trachea
  8. Hard Nodule on palpation

V. Evaluation

VI. Prognosis

  1. Papillary carcinoma
    1. Best prognosis of Thyroid Cancer
    2. Ten year survival: 70-80%
  2. Follicular Carcinoma
    1. Five year survival: 30%
  3. Medullary Carcinoma
    1. Variable prognosis

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