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Unusual types of thyroid neoplasms

K D Burman1, M D Ringel, L Wartofsky

  • 1Section of Endocrinology, Washington Hospital Center, Washington, DC, USA.

Endocrinology and Metabolism Clinics of North America
|March 1, 1996
PubMed
Summary

This article reviews rare thyroid cancers, including papillary (PTC), insular, anaplastic, squamous cell, and lymphoma. Treatment strategies vary based on tumor type and differentiation, influencing thyroid hormone suppression and radioiodine therapy recommendations.

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Area of Science:

  • Endocrinology
  • Oncology
  • Pathology

Background:

  • Primary thyroid neoplasms encompass a spectrum of rare tumors beyond differentiated thyroid cancer (DTC).
  • Unusual thyroid neoplasms include papillary thyroid carcinoma (PTC) with tall cell variant (TCV), insular carcinoma, anaplastic thyroid carcinoma, primary squamous cell carcinoma, and primary thyroid lymphoma.
  • These rare tumors exhibit diverse clinical behaviors and prognoses, necessitating tailored management strategies.

Purpose of the Study:

  • To discuss the clinical behavior, diagnostic considerations, and treatment approaches for unusual primary thyroid neoplasms.
  • To provide guidance on thyroid hormone suppression and radioiodine therapy based on tumor characteristics and differentiation.
  • To highlight the association of certain thyroid neoplasms with specific clinical syndromes and conditions.

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Main Methods:

  • Review of literature on rare primary thyroid neoplasms.
  • Analysis of clinical behavior, response to therapy, and prognostic factors.
  • Synthesis of recommendations for thyroid-stimulating hormone (TSH) suppression and radioiodine treatment based on tumor type and differentiation.

Main Results:

  • Tall cell variant of PTC and insular carcinoma often show aggressive behavior, potentially responding to thyroid hormone suppression and radioiodine.
  • Anaplastic thyroid carcinoma has a poor prognosis, with potential benefit from surgery and radiation, but typically not radioiodine or hormone suppression.
  • Primary squamous cell carcinoma may present with leukocytosis, fever, and hypercalcemia. Primary thyroid lymphoma is often linked to Hashimoto's thyroiditis, especially in older patients with rapidly growing masses.

Conclusions:

  • Management of rare thyroid neoplasms requires individualized TSH suppression targets. Poorly differentiated tumors not concentrating radioiodine may benefit from TSH levels around 0.1-0.3 mU/mL.
  • Differentiated tumors concentrating radioiodine (e.g., TCV, insular) may require lower TSH levels (0.01-0.1 mU/mL).
  • Non-thyrocyte-derived neoplasms like lymphoma can be managed with TSH levels of 0.5-1.5 mU/mL. Further research is needed due to limitations in current evidence.