Diagnosis and management of carcinoma of the thyroid

Thyroid nodules are a frequent finding but engender concern primarily because of a large size or, occasionally, as a manifestation of a carcinoma. Needle biopsy permits a definite diagnosis in the majority of cases. Well-differentiated thyroid carcinoma is treated by surgery, the extent of which would be based on the gross evidence of the extent of the disease, the histologic features of the lesion, the patient's age and overall medical status, and the need to avoid postoperative complications. The appropriate care after surgery is also based on the individual patient. Medullary thyroid carcinoma is best treated by total thyroidectomy with cervical lymph node dissection on the side of a palpable nodule. Serum calcitonin determinations provide diagnostic and some prognostic data. Anaplastic carcinoma is usually best treated by radiation therapy. The outlook is good for most thyroid carcinoma recognized reasonably early.