1 Anatomy and Physiology of the Thyroid Gland: Clinical Correlates to Thyroid Cancer Nikolaos Stathatos... 3

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1 Contents Foreword to Second Edition by E. Chester Ridgway, MD, MACP... vii Foreword to First Edition by Ernest L. Mazzaferri, MD, MACP... ix Preface... xiii Color Plates... xxiii Contributors... xxv Part I General Considerations I: Thyroid Cancer 1 Anatomy and Physiology of the Thyroid Gland: Clinical Correlates to Thyroid Cancer Nikolaos Stathatos Epidemiology of Thyroid Cancer James J. Figge Molecular Pathogenesis of Thyroid Cancer James J. Figge, Nikolai A. Kartel, Dima Yarmolinsky, and Gennady Ermak Molecular Aspects of Thyroid Cancer in Children Gary L. Francis Oncogenes in Thyroid Cancer Katherine B. Weber and Michael T. McDermott Apoptosis in Thyroid Cancer Su He Wang and James R. Baker, Jr Radiation-Induced Thyroid Cancer James J. Figge, Timothy Jennings, Gregory Gerasimov, Nikolai A. Kartel, Dima Yarmolinsky, and Gennady Ermak Classification of Thyroid Malignancies Yolanda C. Oertel Staging of Thyroid Cancer Leonard Wartofsky Thyroid Cancer in Children and Adolescents Merrily Poth Recombinant Human Thyrotropin Matthew D. Ringel and Stephen J. Burgun xv

2 xvi Contents Part II General Considerations II: Nuclear Medicine 12 History of the Role of Nuclear Medicine in the Thyroid Gland and its Diseases: A Personal Perspective Henry N. Wagner, Jr Prophylaxis against Radiation Exposure from Radioiodine Jacob Robbins and Arthur B. Schneider Radioiodine Whole Body Imaging Frank B. Atkins and Douglas Van Nostrand Primer and Atlas for the Interpretation of Radioiodine Whole-Body Scintigraphy Douglas Van Nostrand, Reetha Bakthula, and Frank B. Atkins False-Positive Radioiodine Scans in Thyroid Cancer Brahm Shapiro, Vittoria Rufini, Ayman Jarwan, Onelio Geatti, Kimberlee J. Kearfott, Lorraine M. Fig, Ian D. Kirkwood, John E. Freitas, and Milton D. Gross Part III The Thyroid Nodule 17. The Thyroid Nodule: Evaluation, Risk of Malignancy, and Management Leonard Wartofsky Fine Needle Aspiration: Technique Yolanda C. Oertel Thyroid Nodules: Cellular and Biochemical Markers for Malignancy Kathleen A. Prendergast Radionuclide Imaging of Thyroid Nodules Douglas Van Nostrand Ultrasonic Imaging of the Neck in Patients with Thyroid Cancer Manfred Blum Thyroid Nodules and Cancer Risk: Surgical Management Orlo H. Clark Part IV Well-Differentiated Thyroid Cancer: Papillary Carcinoma A. Presentation 23 Papillary Cancer: Clinical Aspects Leonard Wartofsky Surgical Approach to Papillary Cancer Orlo H. Clark Papillary Carcinoma: Cytology and Pathology Yolanda C. Oertel and James E. Oertel

3 Contents xvii Part IV Well-Differentiated Thyroid Cancer: B. Initial Management 26 Prescribed Activity for Radioiodine Ablation Douglas Van Nostrand Thyroid Remnant Radioiodine Ablation with Recombinant Human Thyrotropin R. Michael Tuttle and Richard J. Robbins Part IV Well-Differentiated Thyroid Cancer: C. Surveillance 28 Follow-Up Strategy in Papillary Thyroid Cancer Henry B. Burch Levothyroxine Therapy and Thyrotropin Suppression Leonard Wartofsky Thyroglobulin and Thyroglobulin Antibodies: Measurement and Interferences D. Robert Dufour Diagnosis of Recurrent Thyroid Cancer in Patients with Positive Antithyroglobulin Antibodies Matthew D. Ringel Surveillance Radioiodine Whole-Body Scans Douglas Van Nostrand Radionuclide Imaging and Treatment of Thyroid Cancer in Children Gary L. Francis Positron Emission Tomography in Well-Differentiated Thyroid Cancer I. Ross McDougall Alternative Thyroid Imaging Anca M. Avram, Karen C. Rosenspire, Stewart C. Davidson, John E. Freitas, and Milton D. Gross The Stunning Controversy A. Stunning: Untoward Effect of 131 I Thyroid Imaging Prior to Radioablation Therapy Hee-Myung Park and Stephen K Gerard B. Stunning Is Not a Problem I. Ross McDougall C. Stunning: Does it Exist? A Commentary Douglas Van Nostrand Ultrasonic Imaging and Identification of Metastases in Cervical Lymph Nodes Manfred Blum

4 xviii Contents 38 Magnetic Resonance Imaging and Computed Tomography Imaging of Thyroid Cancer James J. Jelinek, Kenneth D. Burman, Richard S. Young, and Alexander S. Mark Management of the Patient with Negative Radioiodine Scan and Elevated Serum Thyroglobulin Leonard Wartofsky Determinants of Prognosis in Papillary Thyroid Carcinoma Henry B. Burch Papillary Cancer: Special Aspects in Children Andrew J. Bauer and Merrily Poth Special Presentations of Thyroid Cancer in Pregnancy, Renal Failure, Thyrotoxicosis, and Struma Ovarii Kenneth D. Burman Thyroglossal Duct Carcinoma Leonard Wartofsky and Nikolaos Stathatos Part IV Well-Differentiated Thyroid Cancer D. Treatment 44 Radiation and Radioactivity John E. Glenn Radioiodine Treatment of Distant Metastases Douglas Van Nostrand I Treatment of Metastatic Thyroid Carcinoma Following Preparation by Recombinant Human Thyrotropin Richard J. Robbins and R. Michael Tuttle Dosimetry: Dosimetrically-Determined Prescribed Activity of Radioiodine for the Treatment of Metastatic Thyroid Carcinoma Frank B. Atkins, Douglas Van Nostrand, and Leonard Wartofsky Radioiodine Dosimetry with Recombinant Human Thyrotropin R. Michael Tuttle and Richard J. Robbins Use of Lithium as an Adjuvant to Radioiodine in the Treatment of Thyroid Cancer Monica C. Skarulis, Marina S. Zemskova, and Jacob Robbins Side Effects of 131 I for Ablation and Treatment of Well-Differentiated Thyroid Carcinoma Douglas Van Nostrand and John Freitas External Radiation Therapy of Papillary Cancer James D. Brierley and Richard W. Tsang

5 Contents xix 52. A. Chemotherapy of Thyroid Cancer: General Principles Lawrence S. Lessin B. Chemotherapy of Well-Differentiated Papillary or Follicular Thyroid Carcinoma Lawrence S. Lessin Thyroid Carcinoma; Metastases to Bone Steven P. Hodak and Kenneth D. Burman Adjunctive Local Approaches to Metastatic Thyroid Cancer Leonard Wartofsky Part V Well-Differentiated Thyroid Cancer: Follicular Carcinoma 55 Follicular Thyroid Cancer: Clinical Aspects Leonard Wartofsky Surgical Management of Follicular Thyroid Cancer Orlo H. Clark Pathology of Follicular Cancer Yolanda C. Oertel Hürthle Cell Carcinoma Kenneth D. Burman and Leonard Wartofsky Radionuclide Imaging, Ablation, and Treatment in Follicular Thyroid Carcinoma Douglas Van Nostrand Follow-Up Strategy in Follicular Thyroid Cancer Henry B. Burch PET in Follicular Cancer, Including Hürthle Cell Cancer I. Ross McDougall Follicular Thyroid Cancer: Special Aspects in Children and Adolescents Andrew J. Bauer External Radiation Therapy of Follicular Carcinoma James D. Brierley and Richard W. Tsang Determinants of Prognosis in Patients with Follicular Thyroid Carcinoma Henry B. Burch Part VI Variants of Thyroid Cancer 65. Miscellaneous and Unusual Types of Thyroid Cancer Kenneth D. Burman, Matthew D. Ringel, and Barry M. Shmookler Pathology of Miscellaneous and Unusual Cancers of the Thyroid James E. Oertel and Yolanda C. Oertel

6 xx Contents Part VII Undifferentiated Tumors: Medullary Thyroid Carcinoma 67 Clinical Aspects of Medullary Thyroid Carcinoma Douglas W. Ball Pathology of Medullary Thyroid Cancer James E. Oertel and Yolanda C. Oertel Medullary Carcinoma of the Thyroid: Surgical Management Orlo H. Clark Radionuclide Imaging of Medullary Carcinoma: Utility of Radiolabeled Somatostatin Analogs and Other Radiotracers Giuseppe Esposito PET in Medullary Thyroid Cancer I. Ross McDougall External Radiation Therapy of Medullary Cancer James D. Brierley and Richard W. Tsang Medullary Carcinoma of the Thyroid: Chemotherapy Lawrence S. Lessin Part VIII Undifferentiated Tumors: Thyroid Lymphoma 74 Thyroid Lymphoma Steven I. Sherman Pathology of Lymphoma of the Thyroid Yolanda C. Oertel and James E. Oertel FDG-PET Scanning in Lymphoma and Lymphoma of the Thyroid I. Ross McDougall Part IX Undifferentiated Tumors: Anaplastic Thyroid Cancer 77 Anaplastic Carcinoma: Clinical Aspects Steven I. Sherman Surgical Management of Anaplastic Thyroid Carcinoma Orlo H. Clark Pathology of Anaplastic Carcinoma James E. Oertel and Yolanda C. Oertel PET Scanning in Anaplastic Cancer of the Thyroid I. Ross McDougall

7 Contents xxi 81 External Radiation Therapy of Anaplastic Thyroid Cancer James D. Brierley and Richard W. Tsang Chemotherapy for Anaplastic Thyroid Cancer Lawrence S. Lessin Anaplastic Carcinoma: Prognosis Steven I. Sherman Part X New Frontiers and Future Directions 84 Advances in Radiation Therapy James D. Brierley and Richard W. Tsang New Approaches in Nuclear Medicine for Thyroid Cancer Douglas Van Nostrand Alternative Options and Future Directions for Thyroid Cancer Therapy Matthew D. Ringel Potential Approaches to Chemotherapy of Thyroid Cancer in the Future Lawrence S. Lessin Part XI Resources for Patients with Thyroid Cancer 88 Low Iodine Diets Kenneth D. Burman Appendix A: Books and Manuals Douglas Van Nostrand Appendix B: Additional Sources of Information: Support Groups, Websites and Additional Information Douglas Van Nostrand Appendix C: Forms and Instructions for Patients Treated with Radioactivity John E. Glenn Index

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