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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.