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Thyroid Cancer A Case-Based Approach Giorgio Grani David S. Cooper Cosimo Durante Editors Second Edition 123 Thyroid Cancer Giorgio Grani • David S. Cooper Cosimo Durante Editors Thyroid Cancer A Case-Based Approach Second Edition Editors Giorgio Grani David S. Cooper Department of Translational and Precision Division of Endocrinology, Diabetes, and Medicine Metabolism Sapienza University of Rome The Johns Hopkins University School Rome of Medicine Italy Baltimore, MD USA Cosimo Durante Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy ISBN 978-3-030-61918-3 ISBN 978-3-030-61919-0 (eBook) https://doi.org/10.1007/978-3-030-61919-0 © Springer Nature Switzerland AG 2016, 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface to the Second Edition There have been few instances in the field of thyroidology as startling and dramatic as the epidemic of differentiated thyroid cancer in virtually all developed and devel- oping countries around the world. Whether this is due, as many suspect, to increases in radiologic procedures and screening, or to environmental factors, such as radia- tion, or both, continues to be a matter of intense debate. However, for the clinicians caring for the large number of new and prevalent thyroid cancer patients, there is no debate about the need for current, practical, and evidence-based information on management. This is especially the case for our patients with low-risk papillary thyroid cancer, who represent the vast majority of thyroid cancer patients in the twenty-first century. In this group, we are learning that “less is more” in terms of the traditional treatments of surgery, radioiodine, and thyroxine suppressive therapy. Also, the need for immediate biopsy (and surgery) in the case of small, subcentime- ter, low-risk suspected papillary thyroid cancer is questioned. On the other end of the spectrum, patients with more advanced disease are benefitting from new targeted therapies with a host of new pharmaceutical agents, as well as local treatments directed at individual metastatic lesions. In addition, new approaches to less com- mon forms of thyroid malignancy, including medullary thyroid cancer and anaplastic cancer, are also being developed. There are textbooks of thyroid disease in general and of thyroid cancer specifically; they provide the reader with a vast amount of important information related to etiology, epidemiology, diagnosis, and management. We also know that there are extensive data available electronically that provide helpful guidance with the click of a mouse. The object of this text, however, is to provide the practitioner with clini- cally relevant information in the context of the classical medical learning tool, the case history. These illustrative thyroid cancer cases have been selected to cover the almost innumerable clinical issues encountered in the care of thyroid cancer patients. The textbook begins with cases highlighting the initial management of differentiated thyroid cancer. Part I includes diagnostic difficulties in patients with indeterminate thyroid nodules and encompasses a host of examples of the initial management of differentiated thyroid cancer of varying degrees of complexity. Part II provides case v vi Preface to the Second Edition histories of patients who are undergoing postoperative follow-up with surveillance of varying degrees of intensity, including those who have undergone lobectomy as well as patients discovered to have metastatic disease. Part III presents special issues in thyroid cancer, including the management of thyroid cancer in pregnant patients, the elderly, and in those who have had postsurgical complications such as hypoparathyroidism and recurrent laryngeal nerve damage. Part IV comprises case histories of high-risk patients with local or distant metastatic disease, including children and the elderly. Part V presents a series of patients with locally invasive and/or widely metastatic disease who have become radioiodine refractory. This sec- tion includes detailed discussions of “targeted therapies,” their indications, adverse effects, and expected therapeutic outcomes. Finally, we have included individual sections devoted to the care of patients with medullary thyroid cancer and anaplastic thyroid cancer. For this second edition, we have invited Giorgio Grani, M.D., Ph.D., from the University of Rome to edit the volume with us, and we have asked all contributors to update their cases to reflect current evidence-based practice. Some chap- ters were removed, and others added, to reflect the changing picture of thyroid cancer care over the last five years. All the case histories are written by an international group of authorities in the field of thyroid cancer, and all recommendations are based on evidence-based clinical practice guidelines and data from the recent published literature. We wish to thank all the contributors to the book. They have done what we asked: to ensure that their case reports were brief, succinct, and current, and to provide guidance in areas of controversy. We also wish to thank our partners at Springer for their superb assis- tance and support in the production of the book. We hope this novel text will provide guidance to all those who seek to increase their understanding of thyroid cancer management. Rome, Italy Giorgio Grani, MD, PhD Baltimore, MD, USA David S. Cooper, MD Rome, Italy Cosimo Durante, MD, PhD Contents Part I Differentiated Thyroid Cancer: Initial Management 1 A Patient with a Single Thyroid Nodule Suspicious for Follicular Neoplasm According to the Bethesda System for Reporting Thyroid Cytopathology: Molecular Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dimpi Desai and Susan J. Mandel 2 A Young Patient with Intrathyroidal Papillary Thyroid Cancer and Family History of Differentiated Thyroid Cancer . . . . . 13 Giorgio Grani, Valeria Ramundo, and Cosimo Durante 3 A Case of a Small (1–2 cm) Papillary Thyroid Cancer in a Young Patient: Lobectomy Versus Total Thyroidectomy . . . . . . . 19 Gerard M. Doherty 4 A Patient with Papillary Microcarcinoma Undergoing Active Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Laura Boucai 5 Completion Thyroidectomy in a Patient with Low-Risk Papillary Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 David S. Cooper 6 Papillary Thyroid Cancer with Microscopic Extra-thyroidal Extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Donald S. A. McLeod 7 A Small Papillary Thyroid Cancer with Angioinvasion . . . . . . . . . . . 55 Michael E. Hopkins and Iain J. Nixon 8 A Patient with a Pathological Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 David Carruthers and Steven P. Hodak vii viii Contents 9 Papillary Thyroid Cancer with Central Neck Lymph Node Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Alyse S. Goldberg, Lorne E. Rotstein, and Anna M. Sawka 10 A Patient with a Large Minimally Invasive Follicular Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Jina Kim, Wen T. Shen, and Julie Ann Sosa 11 An Adolescent with Papillary Thyroid Carcinoma and Locally Metastatic Disease but No Distant Metastases . . . . . . . . 93 Sarah J. Bottomley and Steven G. Waguespack Part II D ifferentiated Thyroid Cancer: Postoperative Follow-Up 12 A Patient with Papillary Thyroid Cancer and Biochemical Evidence of Possible Residual Disease at the One-Year Follow-Up Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Valeria Ramundo, Sebastiano Filetti, and Cosimo Durante 13 A Patient with Low-Risk Papillary Thyroid Cancer Who Has Undergone a Lobectomy: Monitoring for Recurrent Disease and Assessment of Thyroid Function . . . . . . . . . . 113 Fernanda Vaisman and Marcela Vaisberg Cohen 14 A Patient with Papillary Thyroid Carcinoma and Biochemical Evidence of Disease at Follow-Up Visits and Increasing Serum Tg Values at Follow-Up Assessments . . . . . . . 119 Yasuhiro Ito and Akira Miyauchi 15 A Young Patient with Recurrent Lymph Node Involvement: Imaging, Cytology, and Thyroglobulin Washout . . . . . . . . . . . . . . . . . 131 Valeria Ramundo, Sebastiano Filetti, and Cosimo Durante Part III D ifferentiated Thyroid Cancer: Special Issues 16 Papillary Thyroid Carcinoma Diagnosed During Pregnancy . . . . . . . 141 Zachary Simons and David S. Cooper 17 Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Swaytha Yalamanchi and David S. Cooper 18 A Case with Postsurgical Hypoparathyroidism: Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Jessica Pepe and Salvatore Minisola 19 A Patient with Postsurgical Recurrent Laryngeal Nerve Damage and Nerve Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 David L. Steward and Adam D. Goodale Contents ix Part IV D ifferentiated Thyroid Cancer: Managing higher risk patients 20 A Case of Papillary Thyroid Cancer Without Aggressive Histological Features with a Nodal Metastasis Detected During Follow-Up in a Young Patient . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Lucia Brilli, Tania Pilli, Furio Pacini, and Maria Grazia Castagna 21 A Patient with a Large Hürthle Cell Carcinoma of the Thyroid and Nodal Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Leonard Wartofsky 22 A Case of a Large, Invasive PTC with Gross Residual Disease (pT4) After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Meredith Giuliani and James Brierley 23 A Patient with Papillary Carcinoma of the Thyroid with Elevated Serum Thyroglobulin but Negative Imaging Studies . . . . . . 201 Leonard Wartofsky 24 A Child with Papillary Thyroid Cancer and Metastatic Pulmonary Disease: Role of Radioactive Iodine Therapy . . . . . . . . . . 209 Monica L. Arango and Steven G. Waguespack 25 A Patient with Bone Metastases from Follicular Carcinoma of the Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Leonard Wartofsky 26 Radioiodine Therapy in Lactating Women with Higher-Risk Differentiated Thyroid Cancer . . . . . . . . . . . . . . . . 231 Swaytha Yalamanchi and David S. Cooper Part V Differentiated Thyroid Cancer: Beyond Radioactive Iodine Therapy 27 A Case of a Patient with RAI-Refractory Differentiated Thyroid Cancer with Progressive Neck Disease and Stable Lung Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Dana M. Hartl, Joanne Guerlain, and Ingrid Breuskin 28 A Case of Fistula After Adjuvant External Beam Radiotherapy and Lenvatinib for High-Risk Follicular Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Carmen Kut, Angela Liang, and Ana P. Kiess 29 RAI Refractory Differentiated Thyroid Cancer with Multiple-Organ Progressive Disease . . . . . . . . . . . . . . . . . . . . . . . 261 Steven I. Sherman 30 RAI-Refractory Differentiated Thyroid Cancer and Lung Lesions Causing Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Steven I. Sherman x Contents 31 A Patient with Follicular Thyroid Cancer and a Painful Bone Metastases at Risk for Pathologic Fracture . . . . . . . . . . . . . . . . 275 Virginia Liberini, Monica Finessi, and Désirée Deandreis 32 Differentiated Thyroid Cancer and Brain Metastases . . . . . . . . . . . . . 297 Steven I. Sherman 33 RAI-Refractory, Advanced Differentiated Thyroid Cancer Receiving Kinase Inhibitor Treatment: Checking for Drug- Drug Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Steven I. Sherman Part VI Medullary Thyroid Cancer 34 Management of Postoperative Hypercalcitoninemia in Medullary Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Douglas W. Ball 35 Tumor Related- and Non-tumor-Related Diarrhea in a Medullary Thyroid Cancer Patient . . . . . . . . . . . . . . . . . . . . . . . . 319 Rosa Falcone, Valeria Ramundo, and Giorgio Grani 36 Clinical Management of a Patient with a Locally Recurrent Medullary Thyroid Cancer and Asymptomatic Slowly Progressing Distant Metastases . . . . . . . . . . . . . . . . . . . . . . . . . 327 Virginia Cappagli, Valeria Bottici, and Rossella Elisei 37 A Patient with an Advanced Medullary Thyroid Cancer and Progressive, Symptomatic Distant Metastases: When to Start Systemic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 Carlotta Giani, Antonio Matrone, and Rossella Elisei 38 Medical Treatment Decision-Making for Advanced Medullary Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Ramona Dadu and Mimi I. Hu 39 Screening Leading to Diagnosis of C cell Hyperplasia . . . . . . . . . . . . 361 Giuseppe Costante 40 Increased Basal Calcitonin in Nodular Goiter: Is It Micromedullary Thyroid Cancer? . . . . . . . . . . . . . . . . . . . . . . . . 367 Andreas Machens and Henning Dralle 41 Timing and Extent of Surgery for a Pediatric Patient with Hereditary MTC and Positive Screening for the p.S891A RET Mutation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375 Henning Dralle and Andreas Machens