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Differentiated Thyroid Carcinoma
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Differentiated thyroid carcinoma (DTCa)
            • Definitions

              • Malignancy arising from epithelial thyroid cells with well-defined histology
                • Papillary or follicular, with multiple variants
                • Papillary carcinoma, papillary adenocarcinoma
                  • Tall cell, insular, and follicular (mixed) variants
                • Follicular carcinoma, follicular adenocarcinoma
                  • Hürthle cell variant

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Hoang JK et al: Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 12(2):143-50, 2015
                                              2. Noda Y et al: MRI of the thyroid for differential diagnosis of benign thyroid nodules and papillary carcinomas. AJR Am J Roentgenol. 204(3):W332-5, 2015
                                              3. Samir AE et al: Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane. Radiology. 277(2):565-73, 2015
                                              4. Zhang Y et al: Diagnostic radiography exposure increases the risk for thyroid microcarcinoma: a population-based case-control study. Eur J Cancer Prev. 24(5):439-46, 2015
                                              5. Trybek T et al: The role of 18F-Fluorodeoxyglucose Positron Emission Tomography in patients with suspected recurrence or metastatic differentiated thyroid carcinoma with elevated serum thyroglobulin and negative I-131 whole body scan. Nucl Med Rev Cent East Eur. 17(2):87-93, 2014
                                              6. Glazer DI et al: SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics. 33(2):397-418, 2013
                                              7. Kato H et al: Necrotic cervical nodes: usefulness of diffusion-weighted MR imaging in the differentiation of suppurative lymphadenitis from malignancy. Eur J Radiol. 82(1):e28-35, 2013
                                              8. Saindane AM: Pitfalls in the staging of cancer of thyroid. Neuroimaging Clin N Am. 23(1):123-45, 2013
                                              9. Xue YL et al: Value of ¹³¹I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 40(5):768-78, 2013
                                              10. Aiken AH: Imaging of thyroid cancer. Semin Ultrasound CT MR. 33(2):138-49, 2012
                                              11. Maruoka Y et al: Incremental diagnostic value of SPECT/CT with 131I scintigraphy after radioiodine therapy in patients with well-differentiated thyroid carcinoma. Radiology. 265(3):902-9, 2012
                                              12. Seo YL et al: Detection of neck recurrence in patients with differentiated thyroid cancer: comparison of ultrasound, contrast-enhanced CT and (18)F-FDG PET/CT using surgical pathology as a reference standard: (ultrasound vs. CT vs. (18)F-FDG PET/CT in recurrent thyroid cancer). Eur Radiol. 22(10):2246-54, 2012
                                              13. Wu LM et al: The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: A meta-analysis. Eur J Radiol. 81(8):1798-805, 2012
                                              14. Erdem G et al: Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Magn Reson Imaging. 31(1):94-100, 2010
                                              15. Hall FM: Identification, biopsy, and treatment of poorly understood premalignant, in situ, and indolent low-grade cancers: are we becoming victims of our own success? Radiology. 254(3):655-9, 2010
                                              16. Heston TF et al: Molecular imaging in thyroid cancer. Cancer Imaging. 10(1):1-7, 2010
                                              17. Mihailovic J et al: MRI versus ¹³¹I whole-body scintigraphy for the detection of lymph node recurrences in differentiated thyroid carcinoma. AJR Am J Roentgenol. 195(5):1197-203, 2010
                                              18. Moon HJ et al: Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 255(1):260-9, 2010
                                              19. Razfar A et al: Clinical usefulness of positron emission tomography-computed tomography in recurrent thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 136(2):120-5, 2010
                                              20. Wong KK et al: Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma. Br J Radiol. 82(982):860-76, 2009
                                              21. Agarwal V et al: Indications for PET/CT in the head and neck. Otolaryngol Clin North Am. 41(1):23-49, v, 2008
                                              22. Aygun N: Imaging of recurrent thyroid cancer. Otolaryngol Clin North Am. 41(6):1095-106, viii, 2008
                                              23. Johnson NA et al: Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiology. 249(2):429-44, 2008
                                              24. King AD: Imaging for staging and management of thyroid cancer. Cancer Imaging. 8:57-69, 2008
                                              25. Loevner LA et al: Cross-sectional imaging of the thyroid gland. Neuroimaging Clin N Am. 18(3):445-61, vii, 2008
                                              26. Newman JG et al: Surgical approaches in thyroid cancer: what the radiologist needs to know. Neuroimaging Clin N Am. 18(3):491-504, viii, 2008
                                              27. Rutherford GC et al: Nuclear medicine in the assessment of differentiated thyroid cancer. Clin Radiol. 63(4):453-63, 2008
                                              28. Miyakoshi A et al: Magnetic resonance imaging of thyroid cancer. Top Magn Reson Imaging. 18(4):293-302, 2007
                                              29. Cohen EG et al: Postoperative management of differentiated thyroid cancer. Otolaryngol Clin North Am. 36(1):129-57, 2003
                                              30. Kinder BK: Well differentiated thyroid cancer. Curr Opin Oncol. 15(1):71-7, 2003
                                              31. Gross ND et al: MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope. 111(11 Pt 1):1905-9, 2001
                                              32. Frilling A et al: Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma. Surgery. 128(6):1067-74, 2000
                                              33. Leger AF et al: Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy. Br J Radiol. 73(876):1260-4, 2000
                                              34. Muros MA et al: Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels. Am J Surg. 179(6):457-61, 2000
                                              35. Takashima S et al: Differentiated thyroid carcinomas. Prediction of tumor invasion with MR imaging. Acta Radiol. 41(4):377-83, 2000
                                              36. Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5): 1105-29, 2000
                                              37. Mazzaferri EL: An overview of the management of papillary and follicular thyroid carcinoma. Thyroid. 9(5):421-7, 1999
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Differentiated thyroid carcinoma (DTCa)
                                                        • Definitions

                                                          • Malignancy arising from epithelial thyroid cells with well-defined histology
                                                            • Papillary or follicular, with multiple variants
                                                            • Papillary carcinoma, papillary adenocarcinoma
                                                              • Tall cell, insular, and follicular (mixed) variants
                                                            • Follicular carcinoma, follicular adenocarcinoma
                                                              • Hürthle cell variant

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Hoang JK et al: Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 12(2):143-50, 2015
                                                                                          2. Noda Y et al: MRI of the thyroid for differential diagnosis of benign thyroid nodules and papillary carcinomas. AJR Am J Roentgenol. 204(3):W332-5, 2015
                                                                                          3. Samir AE et al: Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane. Radiology. 277(2):565-73, 2015
                                                                                          4. Zhang Y et al: Diagnostic radiography exposure increases the risk for thyroid microcarcinoma: a population-based case-control study. Eur J Cancer Prev. 24(5):439-46, 2015
                                                                                          5. Trybek T et al: The role of 18F-Fluorodeoxyglucose Positron Emission Tomography in patients with suspected recurrence or metastatic differentiated thyroid carcinoma with elevated serum thyroglobulin and negative I-131 whole body scan. Nucl Med Rev Cent East Eur. 17(2):87-93, 2014
                                                                                          6. Glazer DI et al: SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics. 33(2):397-418, 2013
                                                                                          7. Kato H et al: Necrotic cervical nodes: usefulness of diffusion-weighted MR imaging in the differentiation of suppurative lymphadenitis from malignancy. Eur J Radiol. 82(1):e28-35, 2013
                                                                                          8. Saindane AM: Pitfalls in the staging of cancer of thyroid. Neuroimaging Clin N Am. 23(1):123-45, 2013
                                                                                          9. Xue YL et al: Value of ¹³¹I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 40(5):768-78, 2013
                                                                                          10. Aiken AH: Imaging of thyroid cancer. Semin Ultrasound CT MR. 33(2):138-49, 2012
                                                                                          11. Maruoka Y et al: Incremental diagnostic value of SPECT/CT with 131I scintigraphy after radioiodine therapy in patients with well-differentiated thyroid carcinoma. Radiology. 265(3):902-9, 2012
                                                                                          12. Seo YL et al: Detection of neck recurrence in patients with differentiated thyroid cancer: comparison of ultrasound, contrast-enhanced CT and (18)F-FDG PET/CT using surgical pathology as a reference standard: (ultrasound vs. CT vs. (18)F-FDG PET/CT in recurrent thyroid cancer). Eur Radiol. 22(10):2246-54, 2012
                                                                                          13. Wu LM et al: The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: A meta-analysis. Eur J Radiol. 81(8):1798-805, 2012
                                                                                          14. Erdem G et al: Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Magn Reson Imaging. 31(1):94-100, 2010
                                                                                          15. Hall FM: Identification, biopsy, and treatment of poorly understood premalignant, in situ, and indolent low-grade cancers: are we becoming victims of our own success? Radiology. 254(3):655-9, 2010
                                                                                          16. Heston TF et al: Molecular imaging in thyroid cancer. Cancer Imaging. 10(1):1-7, 2010
                                                                                          17. Mihailovic J et al: MRI versus ¹³¹I whole-body scintigraphy for the detection of lymph node recurrences in differentiated thyroid carcinoma. AJR Am J Roentgenol. 195(5):1197-203, 2010
                                                                                          18. Moon HJ et al: Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 255(1):260-9, 2010
                                                                                          19. Razfar A et al: Clinical usefulness of positron emission tomography-computed tomography in recurrent thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 136(2):120-5, 2010
                                                                                          20. Wong KK et al: Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma. Br J Radiol. 82(982):860-76, 2009
                                                                                          21. Agarwal V et al: Indications for PET/CT in the head and neck. Otolaryngol Clin North Am. 41(1):23-49, v, 2008
                                                                                          22. Aygun N: Imaging of recurrent thyroid cancer. Otolaryngol Clin North Am. 41(6):1095-106, viii, 2008
                                                                                          23. Johnson NA et al: Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiology. 249(2):429-44, 2008
                                                                                          24. King AD: Imaging for staging and management of thyroid cancer. Cancer Imaging. 8:57-69, 2008
                                                                                          25. Loevner LA et al: Cross-sectional imaging of the thyroid gland. Neuroimaging Clin N Am. 18(3):445-61, vii, 2008
                                                                                          26. Newman JG et al: Surgical approaches in thyroid cancer: what the radiologist needs to know. Neuroimaging Clin N Am. 18(3):491-504, viii, 2008
                                                                                          27. Rutherford GC et al: Nuclear medicine in the assessment of differentiated thyroid cancer. Clin Radiol. 63(4):453-63, 2008
                                                                                          28. Miyakoshi A et al: Magnetic resonance imaging of thyroid cancer. Top Magn Reson Imaging. 18(4):293-302, 2007
                                                                                          29. Cohen EG et al: Postoperative management of differentiated thyroid cancer. Otolaryngol Clin North Am. 36(1):129-57, 2003
                                                                                          30. Kinder BK: Well differentiated thyroid cancer. Curr Opin Oncol. 15(1):71-7, 2003
                                                                                          31. Gross ND et al: MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope. 111(11 Pt 1):1905-9, 2001
                                                                                          32. Frilling A et al: Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma. Surgery. 128(6):1067-74, 2000
                                                                                          33. Leger AF et al: Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy. Br J Radiol. 73(876):1260-4, 2000
                                                                                          34. Muros MA et al: Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels. Am J Surg. 179(6):457-61, 2000
                                                                                          35. Takashima S et al: Differentiated thyroid carcinomas. Prediction of tumor invasion with MR imaging. Acta Radiol. 41(4):377-83, 2000
                                                                                          36. Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5): 1105-29, 2000
                                                                                          37. Mazzaferri EL: An overview of the management of papillary and follicular thyroid carcinoma. Thyroid. 9(5):421-7, 1999