Neoplastic

Benign

Follicular adenoma

Malignant

Anaplastic carcinoma Follicular carcinoma Lymphoma Medullary carcinoma Papillary carcinoma of hyperthyroidism and is more common in women age 20 to 50. Treatment modalities include antithyroid medications, radioactive iodine ablation, or surgical excision when medical treatment fails.

Thyroiditis can cause nodular enlargement of the thyroid gland. Subacute thyroiditis may be a cause of intermittent hyperthyroidism from the release of stored thyroid hormone. Chronic lymphocytic (Hashimoto's) thyroiditis can cause diffuse nodular enlargement of the thyroid. Measurement of antithyroid microsomal antibodies is helpful but not specific for this disorder. Fibrous (Riedel's) thyroiditis is a rare cause of thyroid enlargement, and distinction from neoplasia can be difficult.

Neoplasms of the thyroid are classified as malignant or benign tumors. Follicular adenoma is the most common benign tumor. Malignancies include papillary (65%), follicular (20%), medullary (5%), and anaplastic (10%) carcinomas.

The complete reference list is available online at www.expertconsult.com.

The American Academy of Otolaryngology-Head and Neck Surgery Contains resources for physicians seeking information on ENT topics, as well as a section on patient education. www.UTMB.edu/oto/

Dr. Quinn's Online Textbook of Otolaryngology, The Texas Nasal and Sinus Center, The Centers for Cancers of the Head and Neck, The Center for Audiology and Speech Pathology Contains up to date information on all aspects of otolaryngology. www.nidcd.nih.gov

The National Institute on Deafness and other Communication Disorders

Medullary carcinoma is associated with an elevated calcitonin level, with pheochromocytoma and parathyroid hyperplasia in multiple endocrine neoplasia (MEN) IIA, and with pheochromocytoma, mucosal neuromas, ganglioneuroma-tosis, and marfanoid body habitus in MEN IIB. Measurement of urinary catecholamines, vanillylmandelic acid, and meta-nephrine levels is necessary to aid in the diagnosis of pheo-chromocytoma, which must be treated before surgery for medullary thyroid carcinoma. Hypercalcemia is diagnosed by measuring serum calcium levels.

Initial evaluation of a suspected or palpable nodule includes a thyroid ultrasound and TSH level. If the TSH level is low, a radioiodine scan is obtained. If the nodule corresponds to an area of increased uptake, a biopsy is not necessary because almost all "hot" nodules are benign. Ultrasound will define the number and size of nodules and identify characteristics suggesting malignancy.

Fine-needle aspiration biopsy (FNAB) is indicated for nodules larger than 1 cm or with suspicious ultrasound or examination features. Ultrasound guidance may be used to improve the diagnostic yield for difficult-to-palpate nodules (see eFig. 19-9). FNAB is highly accurate. Results are reported as benign, indeterminate, malignant, or nondiagnostic. Benign nodules should be followed with serial examination and ultrasound. Repeat FNAB is indicated with a significant size change. An indeterminate diagnosis may represent a fol-licular lesion. Follicular neoplasms are not distinguishable as benign or malignant because fine-needle aspiration fails to identify the critical factor of vascular or capsular invasion. Therefore, a thyroid lobectomy may be necessary for diagnosis. Alternatively, a radioiodine scan may be obtained and surgery performed if the nodule is "cold." Nondiag-nostic aspirates should undergo repeat FNAB. A malignant diagnosis often requires a total thyroidectomy with central compartment lymphadenectomy. Postoperative radioactive iodine is often given. Risks of thyroid surgery include recurrent laryngeal injury and hypoparathyroidism.

Prognosis for papillary thyroid carcinoma is excellent, especially in younger patients. Prognosis is good for medullary and follicular carcinoma and universally poor for ana-plastic carcinoma (Cooper et al., 2006).

Contains information about hearing, balance, smell, taste, voice, speech, and language www.medlineplus.com

A service from the National Library of Medicine. Contains the most accurate database of the scientific medical literature plus a guide to over 9,000 prescription and OTC medications. www.cochrane.org

The Cochrane Collaboration. Contains reviews of the latest literature in the field of otolaryngology.

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