Upload
logan-gallagher
View
222
Download
4
Embed Size (px)
Citation preview
For Papillary Carcinoma• Surgical treatment • Radioactive therapy • Hormone therapy • Chemotherapy
• Patient must be euthyroid • Antithyroid drugs:– Methimazole – Carbimazole– Propylthiouracil
• For symptomatic relief of Grave’s disease:– Propranolol
• detect and destroy any metastasis and residual tissue in the thyroid 4-6 weeks after surgical thyroid removal .
• Radioiodine treatment used again 6-12 months after initial treatment of metastatic disease where disease recurs or has not fully responded.
• Thyroid hormone replacement of levothyroxine may be given to patients for life after total thyroidectomy– (levothyroxine at 2.5-3.5 mcg/kg/d) to prevent
hypothyroidism and maintain euthyroid levels
• Cisplatin or Doxorubicin has limited efficacy, producing occasional objective responses (generally for short durations).
• Disadvantage: High toxicity – Considered in symptomatic patients with recurrent or
advancing disease.
• Advantage: Improve the quality of life in patients with bone metastases, – Standard protocol for chemotherapeutic management
has not been developed for these patients.
For Grave’s disease• Symptomatic relief• Thyroid suppression• Surgical treatment
• Propranolol may be used for symptomatic relief of tachycardia, tremors, diaphoresis, and anxiety in these patients.
• Thiourea drugs (methimazole, carbimazole, and propylthiouracil)
• Iodinated contrast agents (Iopanoic acid or ipodate sodium)
• Radioactive iodine
• Hartley-Dunhill operation is the surgical treatment of choice in Grave’s disease– total resection of one lobe and a subtotal resection of
the other lobe leaving about 4grams of thyroid tissue
• Thyroid suppression using Thiourea drugs (methimazole, carbimazole, and propylthiouracil) – prevent hormone synthesis
• Iodinated contrast agents (Iopanoic acid or ipodate sodium) – hasten the decline in serum T3 – reduce thyroid vascularity prior to surgery.
Tierney, L.M. et al. (2006). Current Medical Diagnoisis & treatment 45 th editionNorth America: The McGraw-Hill Companies, Inc..
• Lobectomy with isthmectomy in intrathyroidal capillary carcinoma <2cm and no history of neck irradiation
• Follow with suppressive therapy with thyroid hormone up to TSH concentration of <0.1 microunit per mL
Ferri, F.F. (2002) Ferri’s Clinical Advisory. USA: Mosby, Inc.