Hyperfunctioning thyroid carcinoma: A systematic review

Abstract

Hyperthyroidism may be caused by the development of primary or metastatic thyroid carcinoma. The aim of the present study was to collect recently reported cases of hyperfunctioning thyroid carcinoma in order to analyze its pathological characteristics, diagnostic procedures and treatment strategies. A PubMed () search was performed for studies published between January 1990 and July 2017. Full-text articles were identified using the terms, ‘hyperfunctioning thyroid carcinoma/cancer’, ‘malignant hot/toxic thyroid nodule’, or ‘hyperfunctioning papillary/follicular/Hürthle thyroid carcinoma’. Original research papers, case reports and review articles were included. Among all thyroid carcinoma cases included in the present study, the prevalence of follicular thyroid carcinoma (FTC) was ~10%; however, the prevalence of FTC among hyperfunctioning thyroid carcinomas was markedly higher (46.5% in primary and 71.4% in metastatic disease). The size of hyperfunctioning thyroid tumors was considerably larger compared with that of non-hyperfunctioning thyroid tumors, with a mean size of 4.25±2.12 cm in primary hyperfunctioning thyroid carcinomas. In addition, in cases of metastatic hyperfunctioning thyroid carcinoma, tumor metastases were widespread or large in size. The diagnosis of primary hyperfunctioning thyroid carcinoma is based on the following criteria: i) No improvement in thyrotoxicosis following radioactive iodine (RAI) treatment; ii) development of hypoechoic solid nodules with microcalcifications on ultrasound examination; iii) increase in tumor size over a short time period; iv) fixation of the tumor to adjacent structures; and v) signs/symptoms of tumor invasion. The diagnosis of metastatic hyperfunctioning thyroid carcinoma should be considered in patients suffering from thyrotoxicosis who present with a high number of metastatic lesions (as determined by whole-body scanning), or a history of total thyroidectomy. Surgery is the first-line treatment option for patients with primary hyperfunctioning thyroid carcinoma, as it does not only confirm the diagnosis following pathological examination, but also resolves thyrotoxicosis and is a curative cancer treatment. RAI is a suitable treatment option for patients with hyperfunctioning thyroid carcinoma who present with metastatic lesions.

Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers

“…CGRP is generated as an alternative RNA splicing of the CALCA gene encoding calcitonin, CGRP, and catakalcin (procalcitonin). Our group and others [49,50] have confirmed that positivity for CGRP also supports a C cell origin. A subset of unusual calcitonin-negative medullary thyroid carcinomas are characterized by no elevated serum calcitonin levels, no calcitonin expression on immunohistochemistry, and no expression for calcitonin mRNA.…”

“…3c). Metastatic lesions may also preserve the autonomous production of thyroid hormone [49]. A recent series reported an increased risk of malignancy in TSHR-mutant functional thyroid nodules when TSHR mutations occur at high allelic frequency [50].…”

Das „heiße“ Schilddrüsenkarzinom mit einem kritischen Blick auf die Thermoablation

“…Anders als bei dem hier beschriebenen Patienten handelt es sich bei den Patienten mit heißen Schilddrüsenkarzinomen gerade im Vergleich zu den benignen autonomen Adenomen um meist jüngere weibliche Patienten [ 11 ]. Darüber hinaus weisen die meisten Patienten mit einem Karzinom in einem heißen Knoten Zeichen der Hyperthyreose mit erhöhten T3- (76,5 %) und T4-Werten (51,9 %) bei gleichzeitig supprimiertem TSH auf [ 10 , 11 ]. Diese Daten werfen die Frage nach der Definition eines heißen Schilddrüsenkarzinoms auf.…”

“…Wie im vorliegenden Fall handelt es sich bei den heißen Schilddrüsenkarzinomen häufig um follikuläre Karzinome, die nach den Daten eines systematischen Reviews bei knapp 47 % der nichtmetastasierten und bei etwa 72 % der metastasierten hyperfunktionellen Karzinomen nachweisbar sind [ 10 ]. Darüber hinaus zeigen etwa 20 % der papillären Schilddrüsenkarzinome in heißen Knoten eine follikuläre Variante [ 10 ]. Die Ursachen für das gehäufte Auftreten follikulärer Karzinome in autonomen Knoten ist bislang unklar, scheint jedoch durchaus ein gewisses Charakteristikum zu sein.…”

Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students

“…The value of the method is greatly underestimated since the detection of so called “hot nodules” enables a relatively certain exclusion of malignancy in these lesions. Only few cases of autonomously hyperfunctioning TN are reported in the literature, especially if hyperthyroidism coexists [ 20 ]. Recently published cases revealed benign histopathology in >95% of hot TN with intermediate cytology results [ 21 ].…”