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Follicular Thyroid Carcinoma

Clinical Aspects

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Thyroid Cancer

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Abstract

Follicular carcinoma may typically present as a single, painless thyroid nodule in an older (>55 years of age) male, although it is more common in women by twofold or more. Lymphadenopathy due to involved cervical nodes is uncommon, but distant metastases will be present in lung or bone in 10–20% of patients at the time of initial presentation (15–19). At presentation, all routine blood thyroid function tests will be within normal limits, including the serum TSH (except in the presence of severe iodine deficiency and endemic goiter). Serum thyroglobulin (Tg) may be elevated, but a diagnosis should not be inferred from serum Tg levels. Utility of Tg monitoring is discussed elsewhere in this volume (Chapters 22 and 31), and may be adversely affected by the presence of interfering antithyroglobulin antibodies, which usually falsely lower serum Tg levels. This may be more problematic with immunoluminometric assays than with highly specific radioimmunoassays for thyroglobulin (20). Unfortunately, as many as 25–35% of thyroid cancer patients may have underlying Hashimoto’ s disease with positive thyroid autoantibodies. Future management of such patients may be facilitated by measurement of thyroglobulin mRNA in serum (21). Other techniques may allow distinction between circulating thyroglobulin derived from benign versus malignant thyroid tissue (22). Patients with known metastatic or residual thyroid cancer should be followed up by an endocrinologist/thyroid specialist in addition to their primary care physician. The physician should ensure that serum Tg is being measured only in a laboratory of the highest quality. Ideally, this should be in the same laboratory at each follow-up time interval, and the laboratory should provide companion Tg levels on a remeasurement of stored serum from the prior venapuncture. In the postoperative state, a clearly measurable or rising serum Tg while the patient is TSH-suppressed on levothyroxine may be a definite clue to recurrence, but serum Tg levels are usually most useful when measured while the patient is hypothyroid, for example, during preparation for follow-up scanning. The current availability of recombinant human TSH has facilitated monitoring Tg before and after rhTSH stimulation (see Chapter 14).

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  1. Leonard Wartofsky
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Editors and Affiliations

  1. Department of Medicine, Washington Hospital Center, Washington, DC, USA

    Leonard Wartofsky MD, MPH, MACP (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard) (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard)

  2. Uniformed Services University of Health Sciences, Washington, DC, USA

    Leonard Wartofsky MD, MPH, MACP (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard) (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard)

  3. George Washington University of Schools of Medicine, Washington, DC, USA

    Leonard Wartofsky MD, MPH, MACP (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard) (Chairman, Professor of Medicine and Physiology, Clinical Professor of Medicine, Georgetown, Howard)

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Wartofsky, L. (2000). Follicular Thyroid Carcinoma. In: Wartofsky, L. (eds) Thyroid Cancer. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-199-2_27

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  • DOI: https://doi.org/10.1007/978-1-59259-199-2_27

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-6845-9

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