Download For Papillary Carcinoma Surgical treatment Radioactive therapy

For Papillary Carcinoma
• Surgical treatment
• Radioactive therapy
• Hormone therapy
• Chemotherapy
• Patient must be euthyroid
• Antithyroid drugs:
– Methimazole
– Carbimazole
– Propylthiouracil
• For symptomatic relief of Grave’s disease:
– Propranolol
• detect and destroy any metastasis and residual
tissue in the thyroid 4-6 weeks after surgical
thyroid removal .
• Radioiodine treatment  used again 6-12
months after initial treatment of metastatic
disease where disease recurs or has not fully
responded.
• Thyroid hormone replacement of
levothyroxine may be given to patients
for life after total thyroidectomy
– (levothyroxine at 2.5-3.5 mcg/kg/d) to prevent
hypothyroidism and maintain euthyroid levels
• Cisplatin or Doxorubicin has limited efficacy,
producing
occasional
objective
responses
(generally for short durations).
• Disadvantage: High toxicity
– Considered in symptomatic patients with recurrent or
advancing disease.
• Advantage: Improve the quality of life in patients
with bone metastases,
– Standard protocol for chemotherapeutic management
has not been developed for these patients.
For Grave’s disease
• Symptomatic relief
• Thyroid suppression
• Surgical treatment
• Propranolol may be used for symptomatic relief of
tachycardia, tremors, diaphoresis, and anxiety in
these patients.
• Thiourea drugs (methimazole, carbimazole, and
propylthiouracil)
• Iodinated contrast agents (Iopanoic acid or ipodate
sodium)
• Radioactive iodine
• Hartley-Dunhill operation is the surgical treatment
of choice in Grave’s disease
– total resection of one lobe and a subtotal resection of
the other lobe leaving about 4grams of thyroid tissue
• Thyroid suppression using Thiourea drugs
(methimazole, carbimazole, and
propylthiouracil)
– prevent hormone synthesis
• Iodinated contrast agents (Iopanoic acid or
ipodate sodium)
– hasten the decline in serum T3
– reduce thyroid vascularity prior to surgery.
Tierney, L.M. et al. (2006). Current Medical Diagnoisis & treatment 45th editionNorth America: The McGraw-Hill Companies, Inc..
• Lobectomy with isthmectomy in
intrathyroidal capillary carcinoma <2cm
and no history of neck irradiation
• Follow with suppressive therapy with
thyroid hormone up to TSH
concentration of <0.1 microunit per mL
Ferri, F.F. (2002) Ferri’s Clinical Advisory. USA: Mosby, Inc.