Medical management of thyroid disease

Cover
Half Title
Title Page
Copyright Page
Table of Contents
Preface
Editors
Contributors
1: The laboratory and imaging approaches to thyroid disorders
	Jacqueline Jonklaas and David S. Cooper
	Introduction
	Physiology of the hypothalamic-pituitary-thyroid axis
	Laboratory evaluation of thyroid function
		Assays of thyroid hormones
			Total serum iodothyronine concentrations
			Determination of free T4  and T3  concentrations
			Causes of increased T4  and/or T3  concentrations
			Causes of decreased T4  and/or T3  concentrations
		Assays of thyroid-stimulating hormones
			Causes of hypothyrotropinemia
			Causes of hyperthyrotropinemia
		Specialized studies of thyroid function
			Thyroglobulin
			Thyroid autoantibodies
			Tissue responses to thyroid hormone action
	Laboratory evaluation for thyroid disease
		Screening and case findings
	Imaging approach to thyroid disease
		Ultrasonography and nuclear medicine studies
		Ultrasonography
			Technique
			Indications
			Normal thyroid appearance
			Diffuse thyroid disease
			Thyroid nodules
			Risk stratification systems for thyroid nodules
			Lymph nodes
		Nuclear medicine studies
			Technique
			Indications
			Normal thyroid appearance
			Diffuse thyroid disease
			Thyroid nodules
			Ectopic thyroid tissue
			Thyroid cancer
	References
2: The diagnostic evaluation and management of hyperthyroidism due to Graves’  disease, toxic nodules, and toxic multinodular goiter
	David S. Cooper
	Graves’  disease
		Introduction
		Epidemiology
		Pathophysiology
		Diagnosis
			Signs and symptoms
		Laboratory diagnosis
			Thyroid hormone and TSH levels
			24-hour radioiodine uptake
			TSH receptor antibody measurements
			Pitfalls
		Treatment
			Antithyroid drug therapy
			Beta-adrenergic antagonist drugs
			Potassium iodide therapy
			Radioiodine (131 I) therapy for Graves’  disease
			Thyroidectomy for Graves’  disease
			Choice of therapy for Graves’  disease: Summary
		Treatment of Graves’  ophthalmopathy and pretibial myxedema
	Subclinical hyperthyroidism
		Diagnosis
		Treatment
	Thyroid storm
		Treatment (Table 2.6)
	Solitary toxic nodules
		Introduction
		Pathology
		Pathogenesis
		Clinical considerations
		Diagnosis
		Treatment
			Other Treatment Modalities: Percutaneous Ethanol Injection (PEI), Radiofrequency Ablation (RFA), and Laser Therapy
	Toxic multinodular goiter
		Introduction
		Pathogenesis
		Diagnosis
		Treatment
	References
3: Thyroiditis
	Robert C. Smallridge and Victor Bernet
	Thyroiditis
		Chronic lymphocytic thyroiditis
			Treatment
		Silent thyroiditis (non-postpartum)
			Introduction
			Epidemiology
			Pathophysiology
			Diagnosis
			Treatment
		Postpartum thyroiditis
			Introduction
			Epidemiology
			Pathophysiology
			Diagnosis
			Treatment
		Infectious/post-infectious thyroiditis
			Introduction
			Epidemiology
			Pathophysiology
			Diagnosis
			Treatment
		Subacute thyroiditis
			Introduction
			Epidemiology
			Pathophysiology
			Diagnosis
			Treatment
		Riedel’ s thyroiditis
			Etiology
			Pathophysiology
			Diagnosis
			Treatment
		Radiation thyroiditis
			Introduction
			Epidemiology
			Pathophysiology
			Diagnosis
			Treatment
		Trauma-induced thyroiditis
	References
4: Rare forms of hyperthyroidism
	Nicole O. Vietor and Henry B. Burch
	Thyrotropin (TSH)-induced hyperthyroidism
	Thyroid hormone resistance
	Struma ovarii
	Trophoblastic tumors
	Metastatic thyroid cancer
	References
5: Drug-induced thyroid dysfunction
	Victor Bernet and Robert C. Smallridge
	Iodine and iodine-containing products
	Lithium
	Cancer treatment-related drugs
	Immune system modulating-related drugs
	Drugs impacting TSH synthesis or release
	Inhibition of T4 to T3 conversion
	Drugs Impacting thyroxine-binding globulin levels or binding
	Enhanced metabolic clearance of thyroid hormone
	Inhibition of thyroid hormone absorption and/or enterohepatic circulation
	Assay interference
	Thyrotoxicosis related to exogenous sources of thyroid hormone
	Conclusion
	References
6: Hypothyroidism
	Michael T. McDermott
	Introduction
	Classification and etiology
	Clinical manifestations
	Diagnosis
	Screening and case finding for hypothyroidism
	Outcomes of untreated hypothyroidism
	Management/treatment
	Treatment outcomes
	Recommendations regarding treatment for mild hypothyroidism
		Optimal TSH level on replacement therapy
	Factors contributing to increased LT4 requirements
	Combination LT4/LT3 therapy
	Persistent symptoms in patients on levothyroxine replacement therapy
	Adrenal coverage
	Coverage when patients are NPO for surgery, medical illness, or diagnostic procedures
	Conditions that are not hypothyroidism but may appear to be thyroid conditions
		Non-thyroidal illness (euthyroid sick syndrome)
		Steroid responsive encephalopathy associated with autoimmune thyroid disease (SREAAT) [formerly Hashimoto’ s encephalopathy]
		Wilson’ s low T3 syndrome
		Reverse T3 syndrome (reverse T3 dominance syndrome)
	Myxedema coma
	References
7: Thyroid nodules and multinodular goiter
	Poorani N. Goundan and Stephanie L. Lee
	Introduction
	Prevalence
	Pathogenesis
	History and examination
	Laboratory testing
	Imaging
		Ultrasonography
		Thyroid scintigraphy
		Other imaging modalities
	Fine needle biopsy and cytology
	Management and follow-up
	References
8: Differentiated thyroid carcinoma
	Carolyn Maxwell and Jennifer A. Sipos
	Introduction
	Epidemiology
		Oncogenesis
			BRAF
			TERT
			RAS
		Risk factors for the development of thyroid carcinoma
	Tumor histology
		Papillary thyroid carcinoma
			Papillary microcarcinoma
			Papillary cancer within a thyroglossal duct
			Follicular variant papillary carcinoma (FVPTC)
			Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)
			Tall cell variant of PTC
			Columnar cell variant of PTC
			Diffuse sclerosing variant of PTC
			Hobnail variant of PTC
		Follicular thyroid carcinoma
		Hü rthle cell carcinoma (HCC)
	Tumor staging systems and prognostic scoring systems
	Factors influencing prognosis and affecting outcome
	Treatment of papillary and follicular thyroid carcinomas
		Preoperative imaging
		Surgery
			Lymph node dissection
			Completion thyroidectomy
			Surgical complications
			Thyroidectomy during pregnancy
		Initial risk assessment
			Risk stratification based upon the patient’ s clinical status after initial therapy
			Serum thyroglobulin in initial risk assessment
			Imaging in initial risk assessment
		Thyroid hormone therapy
			Levothyroxine (T4) suppression of TSH
		Radioiodine (131 I) therapy
			Goals of therapy
			Decision to use 131 I therapy
			Preparation for 131 I therapy
			Diagnostic whole-body 131 I scan and the stunning effect
			Determining the appropriate 131 I administered activity
			Thyroid remnant ablation
			131 I adjuvant therapy
			Treatment of residual, recurrent, or metastatic carcinoma with 131 I
			Posttreatment scans
		Complications of 131 I
			Immediate complications
			Long-term complications
			Leukemia and second primary malignancy
		Therapies for advanced thyroid cancer
			External beam radiation therapy (EBRT)
			Thermoablation
		Long-term follow-up and monitoring
			Thyroglobulin monitoring
			Imaging
		Response to therapy
			Excellent response to therapy
			Biochemical incomplete response to therapy— Elevated Tg and negative imaging
			Structural incomplete response to therapy— Recurrent or metastatic disease
	References
9: Medullary thyroid carcinoma in medical management of thyroid disease
	Mimi I. Hu, Elizabeth G. Grubbs, and Julie Ann Sosa
	Introduction
	Germline RET  mutation associated with hereditary MTC
		MEN2A and associated features and variants
		MEN2B and associated features
		2015 ATA risk stratification of RET codon mutations
	Clinical presentation and diagnostic workup of MTC
	Surgical management as initial treatment
	Active surveillance of MTC
		Prognostic indicators beyond doubling times
	Regional site-specific or symptom-specific therapies
	Systemic therapies for advanced, progressive disease
		Approved multikinase inhibitors (MKI) for MTC
		When should an MKI be initiated?
		Adverse effects of MKI
		Monitoring for response to targeted therapy
		Other agents in clinical trials
	Conclusion and future directions
	References
10: Anaplastic thyroid carcinoma and thyroid lymphoma
	Ashish V. Chintakuntlawar and Keith C. Bible
	Case example
	Diagnostic approach to a rapidly enlarging thyroid mass
	Anaplastic thyroid carcinoma
		Incidence and demographics
		Natural history and mortality rates
		Prognostic factors
			Diagnosis
		Fine needle aspiration
			Radionuclide studies
			Thyroid ultrasonography
			Other radiologic studies
		Fiberoptic examination of airway and/or esophagus
		Pathology
			Gross features
			Histology
			Genetics
	Airway management
	Concurrent chemoradiotherapy
	Primary thyroid lymphoma
		Case example
		Incidence
		Age and sex distribution
		Hashimoto’ s/chronic lymphocytic thyroiditis and PTL
		Pathology
			Lymphoma cell types and histologic features
		Clinical features
			Symptoms and signs
		Thyroid dysfunction
			Diagnosis
			Serum chemistries and immunoglobulins
		Imaging studies
			Timing of studies
			Ultrasonography
			Computed tomography
			Magnetic resonance imaging
			Radionuclide scanning
		Staging
			Initial disease stage
			Therapy
			Surgery
			Airway protection
			Radiotherapy
			Chemotherapy
			Failure patterns
	References
11: Surgical approach to thyroid disorders
	Vaninder K. Dhillon and Ralph P. Tufano
	Introduction
	Surgical technique
		Identifying the superior and recurrent laryngeal nerves and parathyroid glands
		Closure of the wound
		Preoperative considerations for thyroid surgery
		Postoperative considerations for thyroid surgery
		Postoperative levothyroxine therapy
	Approach to hyperthyroidism
		Approach to thyroid nodules
		Approach to multinodular goiter (substernal component)
		Approach to well-differentiated thyroid carcinomas
		Medullary thyroid carcinoma
		Neck dissection
		Approach to thyroid carcinomas with aerodigestive invasion
		Approach to anaplastic thyroid carcinoma (ATC)
		Reoperative thyroid surgery in patients with DTC
		Thyroid surgery in pediatric patients
		Advances in thyroid surgery— Scarless thyroid surgery
	References
12: Thyroid disease and pregnancy
	Alisha N. Wade and Susan J. Mandel
	Thyroid hormone physiology during gestation
	Thyroid autoimmunity and euthyroidism
	Hypothyroidism
		Diagnosis
		Pregnancy outcome
		Treatment
	Hyperthyroidism
		HCG-associated thyrotoxicosis and hyperemesis gravidarum
		Graves’  disease
			Diagnosis
			Pregnancy outcome
			Treatment
			Lactation
			Fetal/neonatal hyperthyroidism
	Thyroid nodules and thyroid cancer
	References
Index