Thyroid Cancer

Algorithm(s)

PDF algorithm(s) available at www.arupconsult.com.

Thyroid Nodules Testing Algorithm

Clinical Background

Thyroid cancer is the most common endocrine malignancy and represents 1% of all malignancies.

Epidemiology

Incidence - 9/100,000 per year
Age - incidence increases with age
Sex - affects females more frequently than males, but male gender associated with worse prognosis

Risk Factors

Childhood radiation
Familial syndromes
- Multiple endocrine neoplasias - MEN 2
Family history of thyroid cancer

Pathophysiology

Classification based on tumor cell type
- Papillary
  - Prevalence - 80% of thyroid malignancies
  - Sex - F>M
  - Tumor growth
    - Slow, local spread
  - Prognosis - excellent
- Follicular
  - Prevalence - 5-10% of thyroid malignancies
  - Sex - F:M; 3:1
  - Age of onset - 50 years
  - Risk factors - iodine deficiency
  - Tumor growth - greater risk of hematogenous spread
    - Includes variant called Hürthle cell cancer
  - Prognosis - excellent if no hematogenous spread
- Medullary (C-cell)
  - Prevalence - 5-10% of thyroid malignancies
  - Risk factors - MEN 2A and 2B, RET oncogene
  - Tumor growth - more aggressive
    - Elevated calcitonin is a marker
  - Prognosis - good
- Lymphoma
  - Incidence - 2/1,000,000
  - Sex - F:M; 4:1
- Anaplastic
  - Prevalence - 2% of all thyroid malignancies
  - Sex - F:M; 3:1
  - Age of onset - 50-60 years
  - Tumor growth - poorly differentiated
  - Prognosis - poor due to aggressiveness of disease

Clinical Presentation

Enlarged thyroid
Thyroid nodule
Metastasis - hoarseness, neck node involvement

See Also

Multiple Endocrine Neoplasias - MEN

Pheochromocytoma

Thyroid Disease

Thyroid, Autoimmune

Algorithm(s)

PDF algorithm(s) available at www.arupconsult.com.

Thyroid Nodules Testing Algorithm

Tests

Tests generally appear in the order most useful for common clinical situations

Test name: Thyroglobulin, Fine Needle Aspiration (FNA)

ARUP #: 0020753

Methodology: Chemiluminescent Immunoassay

Use:

Aid in confirming the presence or absence of papillary or follicular cell carcinoma

Test name: Thyroglobulin, Serum or Plasma

ARUP #: 0070421

Methodology: Chemiluminescent Immunoassay

Use:

Monitor residual papillary and follicular thyroid cancer after treatment

Limitations:

Thyroglobulin antibodies (anti-TG) are known to interfere with measurement of thyroglobulin

In the presence of anti-TG, thyroglobulin results should be interpreted with caution

Results obtained with different assay methods or kits cannot be used interchangeably

Follow-up:

Test name: Multiple Endocrine Neoplasia Type 2 (MEN2), RET Gene Mutations by Sequencing

ARUP #: 0051390

Methodology: Polymerase Chain Reaction/Sequencing

Use:

Confirm multiple endocrine neoplasia 2 (MEN2) familial syndromes

Limitations:

Follow-up:

Fine needle aspiration of thyroid

Test name: BRAF V600E Mutation in Thyroid by PCR, Paraffin

ARUP #: 0051517

Methodology: Polymerase Chain Reaction/Fluorescence Monitoring Analysis

Use:

May be useful for prognostication purposes in papillary thyroid cancers

Test name: Calcitonin

ARUP #: 0070006

Methodology: Chemiluminescent Immunoassay

Use:

Confirm diagnosis of medullary thyroid carcinoma (MTC)

Screen for MTC in family members

Monitor residual tumors after treatment

Limitations:

Elevated basal calcitonin levels that are unresponsive to stimulating tests are found in patients with disorders other than MTC

Test name: Immunohistochemistry Stain Offering

ARUP #: arup005

Methodology: Immunohistochemistry

Use:

For fixed tissue samples, consultative services as well as immunohistochemical staining for calcitonin, chromogranin A, TSH, thyroglobulin, TTF-1 and PTH are available

References

General References

Benvenga S. Update on thyroid cancer. Horm Metab Res. 2008;40(5):323-328.

Coltrera MD. Evaluation and imaging of a thyroid nodule. Surg Oncol Clin N Am. 2008;17(1):37-viii.

Faquin WC. The thyroid gland: recurring problems in histologic and cytologic evaluation. Arch Pathol Lab Med. 2008;132(4):622-632.

Fischer S, Asa SL. Application of immunohistochemistry to thyroid neoplasms. Arch Pathol Lab Med. 2008;132(3):359-372.

Iervasi A, Iervasi G, Carpi A, Zucchelli GC. Serum thyroglobulin measurement: clinical background and main methodological aspects with clinical impact. Biomed Pharmacother. 2006;60(8):414-424.

Lansford CD, Teknos TN. Evaluation of the thyroid nodule. Cancer Control. 2006;13(2):89-98.

Nikiforova MN, Nikiforov YE. Molecular genetics of thyroid cancer: implications for diagnosis, treatment and prognosis. Expert Rev Mol Diagn. 2008;8(1):83-95.

Orija IB, Pineyro M, Biscotti C, Reddy SS, Hamrahian AH. Value of repeating a nondiagnostic thyroid fine-needle aspiration biopsy. Endocr Pract. 2007;13(7):735-742.

Shibru D, Chung KW, Kebebew E. Recent developments in the clinical application of thyroid cancer biomarkers. Curr Opin Oncol. 2008;20(1):13-18.

Spencer CA, Lopresti JS. Measuring thyroglobulin and thyroglobulin autoantibody in patients with differentiated thyroid cancer. Nat Clin Pract Endocrinol Metab. 2008;4(4):223-233.

Wreesmann VB, Singh B. Clinical impact of molecular analysis on thyroid cancer management. Surg Oncol Clin N Am. 2008;17(1):1-35, vii.

Xing M. BRAF mutation in papillary thyroid cancer: pathogenic role, molecular bases, and clinical implications. Endocr Rev. 2007;28(7):742-762.

References from the ARUP Institute for Clinical and Experimental Pathology Research®

Rowe LR, Bentz BG, Bentz JS. Utility of BRAF V600E mutation detection in cytologically indeterminate thyroid nodules. Cytojournal. 2006;3:10-.

Medical Reviewers

Meikle, A. Wayne, M.D. Medical Director, RIA and Endocrinology at ARUP Laboratories; Professor of Internal Medicine and Pathology, University of Utah

Comprehensive Review: September 2008
Last Update: September 2008