SFGH 12.7 pearls: Papillary Thyroid Cancer and airway obstruction

  • There are 3 types of airway obstruction
    • Central – trachea and main stem bronchi
      • Malignancy is most common cause, usually non-small cell lung cancer. Mets from other cancers and local compression from local cancers, including thyroid, are still rare causes
    • Upper – Nasopharynx, larynx down through proximal trachea
    • Lower – smaller airways, usually due to COPD/asthma
      • Central and upper can co-exist, but lower is usually not associated with the other two
    • Visualization with bronch or laryngoscopy is usually needed for diagnosis. Tissue biopsy is also usually required, but imaging alone can sometimes be sufficient
    • Most patients with papillary thyroid cancer do not die of their disease. However, age >45 at diagnosis, large tumor size and soft tissue invasion and/or metastases increase mortality rates.
      • Recurrence of disease is quite common among all age groups and occurs in nearly 15%
    • Surgery is the main treatment modality and most patients will have a total thyroidectomy if their tumor is >1cm in diameter and/or they have local or distant metastases.
    • TSH suppression goals depend on risk of recurrence. For low risk disease, the TSH goal in 0.1-0.5. For intermediate or high risk, the goal is <0.1 (undetectable)

Evernote link: https://www.evernote.com/shard/s300/sh/46a2866b-45c9-4cd4-90b4-d7434859e324/92e7f0d3f8c2374eb2bf6dc25f73f27e

Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169:1278.

Sherman SI, Angelos P, Ball DW, et al. Thyroid carcinoma. J Natl Compr Canc Netw 2007; 5:568.

American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167.

Sam also shared a helpful resource for looking up treatment guidelines for just about any malignancy. Here is the link to the National Comprehensive Cancer Network guidelines page for future reference!

http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site

 

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