[Endocrine therapy and after-care in thyroid gland carcinoma]

Abstract

The 10 year survival is excellent for stage I disease thyroid carcinoma. Survival decreases as a function of cancer invasion beyond the gland. Papillary and follicular cancers have longterm survival, but anaplastic cancers are lethal and survival is short. In differentiated carcinomas thyroidectomy and neck dissection are followed by radioiodine therapy to eliminate residual tissue and metastases. In case of papillary microcarcinomas a limited resection is justified. There is no need for radioiodine treatment. Thyroid hormones are given postoperatively in a high dose to suppress TSH. An increase of the tumor marker thyreoglobulin indicates the development of relapse or metastases. In medullary carcinoma basal or serum calcitonin levels after stimulation with pentagastrin-elicited are pathognomonic for a relapse. 25% of the medullary thyroid carcinomas are observed in families. Genetic screening is mandatory in patients with medullary carcinoma. Serum calcium values should be controlled to exclude safely hypoparathyroidism with certitude.