Standard Treatment A total thyroidectomy is done, with a thorough central neck cleanout, meaning that all fibrofatty and lymphoid tissue is removed. If regional nodes are involved and the primary tumor is larger than 3/4 in. (2 cm), a modified radical neck dissection is done on the same side.
If the tumor is confined to the thyroid gland, almost all patients will be cured. In general, there is no benefit to radioactive iodine therapy, radiotherapy or chemotherapy , although occasional responses to these treatments are seen in metastatic disease.
Treatment for metastatic disease has generally been unsatisfactory, pointing up the need for detection and diagnosis while the tumor is confined to the thyroid and can be cured surgically. Patients with metastatic disease benefit from palliative surgery. They may have significant symptoms, especially severe diarrhea, related to the hormone produced by the tumor. This usually responds to treatment with somatostatin or nutmeg.
Five-Year Survival 40 to 95 percent. Survival is best in familial medullary thyroid cancer without other aspects of MEN, and intermediate for sporadic and for MEN IIA. It is worst for patients with MEN IIB, that is in patients with a marfanoid habitue, mucosal neuromas, pheochromocytomas and ganglioneuromatosis.
Anaplastic Thyroid Carcinoma
There are large cell and small cell types. Both grow rapidly and extend beyond the thyroid.
