Cancer of the Thyroid*†

The management of the solitary thyroid nodule: a review

“…These include age, sex, size and extent of primary tumour, local invasion, lymph nodule involvement, distant metastases, incomplete resection and histopathology. 26–46,48–54,57–62 The relevance of these is that they can help decide on the management of patients with a solitary nodule containing differentiated thyroid cancer (i.e. extent of surgery ± postoperative radioiodine).…”

“…The first was described in 1954 when age was identified as a prognostic factor. 58–59 In 1979, Byar and the European Organization for Research on Treatment of Cancer (EORTC) developed a prognostic index based on the multivariate analysis of 507 patients with all histological types of thyroid cancer. 60 They identified age, sex, histology, extrathyroidal invasion and distant metastases as statistically significant and developed a scoring system.…”

“…64 Similar prognostic factors have been identified in other retrospective studies. 54–67 The prognostic factors for follicular carcinoma have also been identified, the main difference being that sex may not be a significant risk factor. 65–69 …”

“…However, because of the more aggressive nature of this tumour, many patients with tumours measuring > 1 cm (or any tumour with significant capsular or angio‐invasion) will require near‐total or total thyroidectomy followed by radio‐iodine ablation, suppression of the TSH with thyroxine and yearly measurement of the serum thyroglobulin. 15–78 Some authors recommend initial total thyroidectomy as it minimises the increased morbidity associated with a second procedure. 79 The rationale for total thyroidectomy in follicular carcinoma is similar to that for papillary carcinoma but in addition, follicular carcinoma has a high incidence of distant metastases and total thyroidectomy facilitates staging of these lesions using 131 I.…”

Seminars in surgical oncology on thyroid cancer

“…The problem of sorting out the prognosis for patients with thyroid cancer and thus the appropriate surgery and adjuvant therapy presents a conundrum. In the 1950s articles first noted the great difference in outcome between patients under and over the age of 45 [3]. Beginning in the late 1970s, a series of risk stratification schemes were published for differentiated thyroid cancer that essentially all came to the same conclusion.…”