Primary Care Otolaryngology

Chapter 15

Thyroid Cancer

Thyroid Nodules and Cancer Thyroid cancer and the management of thyroid masses can be a confusing topic of discussion. Thyroid nodules are singular or multiple, often encap- sulated, growths found on the thyroid gland. They are most frequently benign and so common, particularly with advancing age, as to preclude biopsy and removal in every patient who presents with nodules. However, otolaryngologists often recommend and perform removal of nodules that have a reasonable risk of being cancerous, as determined by multiple fac- tors that include those discussed below. Risk factors for malignant thyroid nodules are based on gender, age, early radiation exposure, and family history of thyroid cancer. While thyroid nodules are much more common in women than in men, a nodule in a male has a higher risk of being cancerous than a nodule in a female. Older people also develop more benign nodules than younger people (i.e., a nodule in a person younger than 40 years old has a higher chance of being

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cancerous than a nodule in a person over 40). In addition, larger nodules and nodules that demonstrate growth are more commonly malignant. The standard accepted and effective method for determination of the contents of a thyroid mass or nodules is fine-needle aspiration biopsy (FNAB). This may be performed with or with- out ultrasound guidance, depending on the size and location of the lesion. While cytopatho- logic interpretation has improved, a clear diag- nosis for malignancy is not always achieved. Reports, such as “indeterminant,” “suspicious,” or “noninformative,” are frequently tendered to the surgeon or endocrinologist, making the

Figure 15.1. Large neck mass eccentrically located in the right neck.

Primary Care Otolaryngology