Thyroid carcinomas are fairly uncommon and include disease types that range from indolent localised papillary carcinomas to the fulminant and lethal anaplastic disease. Several attempts to formulate a consensus about treatment of thyroid carcinoma have resulted in published guidelines for diagnosis and initial disease management. Multimodality treatments are widely recommended, although there is little evidence from prospective trials to support this approach. Surgical resection to achieve local disease control remains the cornerstone of primary treatment for most thyroid cancers, and is often followed by adjuvant radioiodine treatment for papillary and follicular types of disease. Thyroid hormone replacement therapy is used not only to rectify postsurgical hypothyroidism, but also because there is evidence to suggest that high doses that suppress thyroid stimulating hormone prevent disease recurrence in patients with papillary or follicular carcinomas. Treatment for progressive metastatic disease is often of limited benefit, and there is a pressing need for novel approaches in treatment of patients at high risk of disease-related death. In families with inherited thyroid cancer syndromes, early diagnosis and intervention based on genetic testing might prevent poor disease outcomes. Care should be carefully coordinated by members of an experienced multidisciplinary team, and patients should be provided with education about diagnosis, prognosis, and treatment options to allow them to make informed contributions to decisions about their care.
The epidemiology of thyroid carcinoma
Thyroid cancer is one of the rarest forms of cancer, yet there are wide variations in the degree of malignancy, ranging from the most rapidly fatal to the relatively benign. This is almost entirely dependent on the histological type. Generally speaking, data available on changing trends of incidence and mortality are subject to reservation, dependent on the degree to which they have been influenced by changing diagnostic criteria and the precision of histopathological description. Nevertheless, there is evidence that mortality is slowly decreasing, while incidence is slowly increasing. The purpose of this review is to try to interpret the temporal trends of incidence and mortality rates for thyroid carcinoma in the last 3 decades in light of the problems arising from changes in diagnostic standards and histological classification regarding thyroid neoplasms. Attention is also drawn to the implications, from a public health viewpoint, of the present intensive detection and treatment of occult thyroid carcinomas.
Thyroid calcification and its association with thyroid carcinoma
Calcification within the thyroid gland may occur in both benign and malignant thyroid disease, and its detection on ultrasonography is frequently dismissed by many clinicians as an incidental finding of little significance. As a tertiary referral center, most of our thyroid patients will have had thyroid ultrasonography before being referred to us, and in our experience, the incidence of malignancy in a thyroid nodule containing calcification seems to be higher than that in the average thyroid nodule. To assess this risk, we conducted this retrospective review.
Materials and Methods
Our analysis included 462 consecutive patients who underwent thyroid surgery at our institution between 1995 and 1999. We reviewed all the patients’ charts for data regarding clinical findings, preoperative diagnostic investigations, and histopathologic diagnosis. Of the 462 patients, 361 (78.1%) had thyroid ultrasonography before surgery, and 49 (13.6%) of these ultrasounds showed intrathyroidal calcification.
Of the 49 patients whose ultrasounds showed intrathyroidal calcification, 29 (59.2%) were found on histopathologic examination to have thyroid carcinoma. Twelve of the remaining 20 patients had multinodular goiters. Of the 29 patients with malignancy, seven (24.1%) had preoperative fine-needle aspirates that were reported as benign. After excluding patients who were initially seen with multinodular disease, in the subset of 37 patients who presented with a solitary thyroid lesion with calcification, 28 (75.7%) were found to have carcinoma.
When calcification is noted within a solitary thyroid nodule, the risk of malignancy is very high. Surgery should be recommended regardless of the result of fine-needle aspiration cytologic findings,
Proptosis from Metastatic Thyroid Carcinoma: Case Report and Review
A 70 year old female presented with right sided orbital proptosis since one and half year with past history of thyroidectomy. On examination thyroid swelling was present with right orbital proptosis. Routine blood investigations were normal except the serum thyroglobulin levels, 22000I/U. Histopathological examination (HPE) of the biopsy from the protruding mass from the right orbit showed follicular acini lined with cuboidal cells. CECT (Contrast enhanced computerized tomography) of orbit showed mass in the superior part of retro orbital region eroding the superior wall and extending into right parasellar. A total thyroidectomy was performed and HPE of specimen was suggestive of thyroid papillary carcinoma. For the orbital metastasis patient underwent external beam radiotherapy with 40 Gray in 20 fractions. During her follow up period she was found to have secondary in the left femur metaphysis. Patient refused surgical excision of the bone secondary. Patient is on regular follow up with supportive treatment.
Thyroid Carcinoma in University of Port Harcourt Teaching Hospital
Introduction: Thyroid carcinoma is a relatively uncommon disease with an estimated incidence of less than 1% of all cancers. Most of the thyroid carcinomas are papillary or follicular while medullary and anaplastic cancers are rare. The mainstay of treatment is total thyroidectomy, radioiodine and radiotherapy.
Aim: To review the clinico pathological features and management of thyroid carcinoma as seen in university of Port Harcourt Teaching Hospital.
Patients and Methods: This is an 8 year retrospective study of all patients with thyroid carcinoma managed at the University of Port Harcourt Teaching Hospital from 1st January 2008 to 31st December 2015. Relevant data extracted from the records were analysed using the Statistical Package for Social Sciences (SPSS) version 16.
Results: Thirty two patients with thyroid carcinoma were analysed out of 222 cases of thyroid diseases seen within the study period. There were 10 males and 22 females giving a male to female ratio of 1:2.2. Their ages ranged from 24 to 64 years with a mean of 46.6±3.4 years and peak age incidence was in the 7th decade. Follicular carcinoma was the commonest histological type. All patients had subtotal lobectomy or thyroidectomy and post operative complications were observed in 7 (21.9%) patients. Mortality rate was 3.1%.
Conclusion: Carcinoma of the thyroid was most commonly seen in the 7th decade of life and predominantly in females with follicular carcinoma being the commonest histological type encountered. In order to reduce the incidence of follicular carcinoma, we advocate widespread introduction of dietary iodine supplementation.
 Sherma, S.I., 2003. Thyroid carcinoma. The Lancet, 361(9356), pp.501-511.
 Franceschi, S., Boyle, P., Maisonneuve, P., La Vecchia, C., Burt, A.D., Kerr, D.J. and MacFarlane, G.J., 1993. The epidemiology of thyroid carcinoma. Critical reviews in oncogenesis, 4(1), pp.25-52.
 Khoo, M.L., Asa, S.L., Witterick, I.J. and Freeman, J.L., 2002. Thyroid calcification and its association with thyroid carcinoma. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck, 24(7), pp.651-655.
 Yethadka, R., Vijayakumar, A. and Kumar, K.S., 2014. Proptosis from metastatic thyroid carcinoma: case report and review. Ophthalmology Research: An International Journal, pp.18-23.
 Dodiyi-Manuel, A. and Athanasius, B.P., 2017. Thyroid Carcinoma in University of Port Harcourt Teaching Hospital. Journal of Advances in Medicine and Medical Research, pp.1-5.