Controversies in Thyroid Nodules and Differentiated Thyroid Cancer: A Case-Based Approach

✍ Scribed by Sanziana A. Roman (editor), Wen T. Shen (editor), Julie Ann Sosa (editor)

• Publisher: Springer
• Year: 2023
• Tongue: English
• Leaves: 211
• Category: Library

✦ Synopsis

This book provides a practical, evidence-based approach to controversies in the management of thyroid nodules and differentiated thyroid cancer (DTC). Thyroid nodules are a commonly encountered clinical entity, identified in 2-6% of the population by palpation, and 20-35% by ultrasound. DTC is the solid organ cancer with the most rapidly increasing incidence (>50,000 new cases in the U.S. annually). Despite extensive research and multiple published comprehensive practice guidelines, numerous controversies remain within this field covering a wide range of issues, including incidence and epidemiology, radiographic evaluation, criteria for needle biopsy, cytopathologic and molecular diagnostics, active surveillance vs. operation for low-risk tumors, extent of surgery, indications for radioactive iodine treatment and external beam radiation, and optimal protocols for follow-up.

The book takes a case-based approach: each chapter will begin with a patient presentation highlighting a particular controversial subject in thyroid nodules and DTC. The remainder of the chapter discusses the controversy within the context of current scientific understanding and clinical practice, using the latest evidence-based practice guidelines. Chapters conclude with a final review and discussion of the opening case, with options and recommendations for next steps provided. The recommendations are evidence-based and practical, intended to help guide practitioners in their ongoing care of patients with thyroid nodules and DTC. Each chapter was written by a recognized expert in the area of controversy, including endocrine surgeons, endocrinologists, radiologists, medical oncologists, and nuclear medicine specialists.

Controversies in Thyroid Nodules and Differentiated Thyroid Cancer: A Case-Based Approach is an excellent guide for oncologists, endocrinologists, otorhinolaryngologists, surgeons, and practitioners of all types that care for patients with thyroid nodules and DTC.

✦ Table of Contents

Preface
Contents
Contributors
Chapter 1: Incidence and Epidemiology of Differentiated Thyroid Cancer: Is Thyroid Cancer Incidence Truly Increasing, or Is It Simply a Finder Effect?
Case 1
Overview
True Increase or Overdiagnosis?
Conclusion
References
Chapter 2: Criteria for Fine Needle Aspiration Biopsy in Thyroid Nodules
Ultrasound Features and Size as Predictors of Malignancy
Assessment of Sonographic Risk Stratification Systems
Significance of Clinical History—Risk Factors, Pregnancy, and Comorbidities
Incidentally Discovered Thyroid Nodules
Strengths and Limitations of Fine Needle Aspiration Biopsy
Thyroid Nodule Management—Multiple Nodules and Surveillance
Concluding Remarks
References
Chapter 3: Preoperative Molecular Testing for Indeterminate Thyroid Nodules
Case
Background
Approach to the Patient
Molecular Tests
The Role of Molecular Testing in Determining the Extent of Surgery
Cost-Effectiveness
Back to the Case
Conclusion
References
Chapter 4: Active Surveillance of Low-Risk Differentiated Thyroid Cancer
Case
Rationale for Active Surveillance of Low-risk Thyroid Cancer
Most Thyroid Cancers Have a Favorable Prognosis
Data on Active Surveillance for Low-risk Thyroid Cancer from Case Series Has Been Favorable
Active Surveillance Is Standard of Care for Other Low-risk Cancers
Identifying Candidates for Active Surveillance of Low-Risk Thyroid Cancer
Which Patients Are Appropriate Candidates for Active Surveillance?
Which Patients Should Be Considered for Transient Use of Active Surveillance?
Which Patients Are Inappropriate Candidates for Active Surveillance?
Implementation of Active Surveillance for Low-Risk Papillary Thyroid Cancer
Importance of a Multidisciplinary Medical Team
Treatment Decision-Making
Monitoring with Ultrasound Exams
Potential Benefits of Active Surveillance
When to Consider Transitioning to Surgical Treatment
Limitations of Existing Data and Challenges to Successful Uptake of Active Surveillance
Limitations of Existing Data on Active Surveillance
Challenges to Successful Uptake of Active Surveillance
Case Revisited
Conclusion
References
Chapter 5: Preoperative Laryngoscopy in Thyroid Surgery Patients
Cases
Introduction
The Routine Approach
The Selective Approach
Revisiting the Case
Conclusion
References
Chapter 6: Radiofrequency Ablation for Thyroid Nodules
Case Presentation
Background
Pre-procedure Considerations
Procedure
Post-Procedure Follow-Up
Discussion
Complications
Marginal Regrowth
Potential Malignancy Risk
Case Conclusion
Summary
References
Chapter 7: Management of Low-risk Papillary Thyroid Cancer in a Patient with Familial Non-Medullary Thyroid Cancer
Case Discussion
Controversies in the Management of Low-risk PTC in the Setting of a Family History
Case Summary and Evidence-Based Recommendations for Management
References
Chapter 8: Intraoperative Nerve Monitoring in Thyroid Operations
Case
Importance of Recurrent and Superior Laryngeal Nerves for Voice
Intraoperative RLN and EBSLN Management
Evidence Based Case Management
References
Chapter 9: Extent of Surgery for Low-Risk Papillary Thyroid Cancer
Case
Introduction
Risk Stratification
Management Strategies for Low-Risk PTC
Surgical Treatment
Active Surveillance
Emerging Data on Patient Perspectives for the Management of Low-Risk PTC
Case Conclusion
Summary
References
Chapter 10: Surgical Management of Locally Advanced Thyroid Cancer with Tracheal Invasion
Case
Discussion
Extra-Thyroidal Extension to the Airway
Prognosis of Locally Advanced Thyroid Cancer
Surgical Techniques
Case Discussion
Conclusion
References
Chapter 11: Management of Central Neck Nodes in Papillary Thyroid Cancer
Case Presentation
Background
Preoperative Evaluation
Intraoperative Evaluation
Discovery of an Abnormal LN
Management of Patients with cN0 Disease
Summary of Evidence-Based Recommendations for Management of Clinically N0 Disease in a Patient with a 3-cm PTC
References
Chapter 12: Impact of Surgeon Volume in Thyroid Operations
Case
Background and Discussion of Salient Points Relating to the Controversy
Surgeon Volume and Clinical Outcomes
Surgeon Volume and Oncologic Outcomes
Surgeon Volume Versus Years in Practice
Surgeon Volume Threshold
Surgeon Volume and Lymph Node Dissection
Surgeon Volume, Quality of Life, and Costs
High-Volume Care Versus Access
Return to the Case and Provide a Summary of Evidence-Based Recommendations for Management
References
Chapter 13: Intraoperative/Postoperative Calcium Management in Thyroidectomy
Case
Background
Definition
Risk Factors
Symptoms and Signs
Case
Perioperative Care
Surgical Considerations
Intraoperative PTH, Serum Calcium Testing
Postoperative Management
Case
Prophylactic Management
Case
Mild to Moderate Hypoparathyroidism/Mild Hypocalcemia (7.5–8 mg/dL)
Concurrent Hypomagnesemia
Severe Hypoparathyroidism/Hypocalcemia (<7.5 mg/dL)
Hungry Bone Syndrome
Permanent Surgical Hypoparathyroidism
Case Conclusion
Take Home Points
References
Chapter 14: Indications for Radioactive Iodine
Case
What Is Intermediate Risk?
Indications for RAI for Intermediate-Risk Patients
Side Effects of RAI on Young Patients
Case Follow-Up
References
Chapter 15: Recurrent Nodal Metastases of Papillary Thyroid Cancer
Case
DTC Nodal Recurrence: Epidemiology
Nodal Recurrence Management
TSH Suppression
Surgery
Active Surveillance
Radioactive Iodine
External Beam Radiotherapy
Non-Surgical Ablative Techniques
Radiofrequency Ablation
Percutaneous Ethanol Injection
Case Discussion
Summary
References
Chapter 16: Management of Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Features (NIFT-P)
Case
Background
Definition
History of Classification
Prognosis
Diagnosis
Histologic Features
Diagnostic Controversy
Surgical Management
Thyroid Lobectomy
Surveillance
Case: Suggestions for the Patient
Evidence-Based Recommendations
References
Chapter 17: Timing of Long-Term Postoperative Surveillance for Low-Risk Differentiated Thyroid Cancer
Case
Background
Thyroid Hormone Treatment
Imaging
Thyroglobulin
Summary and Conclusion
References
Chapter 18: External-Beam Radiation for Patients with Differentiated Thyroid Cancer: Is There a Role?
Case
Background and Discussion
Recommendation and Treatment
References
Index