History

Many cases of follicular thyroid cancer (FTC) are subclinical. The most common presentation of thyroid cancer is as an asymptomatic thyroid mass or nodule that can be felt in the neck. Pain seldom is an early warning sign of thyroid cancer.

Record a thorough medical history to identify any risk factors or symptoms. For any patient with a lump in the thyroid that has appeared recently, focus on any prior exposure to ionizing radiation, as well as the cumulative lifetime exposure; 1 Gy of radiation to the thyroid has an estimated attributable risk of 88%. For children, doses as low as 50-100 mGy are associated with an increased risk of thyroid cancer, with a linear dose response up to 10-20 Gy. This risk persists for about 4 years from exposure.^[19] Note that of the thyroid cancers, papillary thyroid carcinoma has the highest risk with ionizing radiation.

Also consider any family history of thyroid cancer.^[20]

Some patients have persistent cough, difficulty breathing, or difficulty swallowing. Other signs and symptoms (eg, pain, stridor, vocal cord paralysis, hemoptysis, rapid enlargement) are rare. Those can be caused by less serious problems.

At diagnosis, 10-15% of patients have distant metastases to bone and lung and initially are evaluated for pulmonary or osteoarticular symptoms (eg, pathologic fracture, spontaneous fracture).

Physical Examination

Palpate the patient's neck to evaluate the size and firmness of the thyroid and to check for any thyroid nodules. The principal sign of thyroid carcinoma is a firm and nontender nodule in the thyroid area.

Some patients have a tight or full feeling in the neck, hoarseness, or signs of tracheal or esophageal compression.

Palpable thyroid nodules are usually solitary, with a hard consistency, an average size of less than 5 cm, and ill-defined borders. This nodule is fixed in respect to surrounding tissues and moves with the trachea at swallowing.

Usually, signs of hyperthyroidism or hypothyroidism are not observed.

Differential Diagnoses

[Guideline] NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/PDF/thyroid.pdf. Version 2.2022 — May 5, 2022; Accessed: June 14, 2022.
Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on Fundamental Mechanisms of Thyroid Cancer. Front Endocrinol (Lausanne). 2020. 11:102. [QxMD MEDLINE Link]. [Full Text].
Johnson TL, Lloyd RV, Thor A. Expression of ras oncogene p21 antigen in normal and proliferative thyroidtissues. Am J Pathol. 1987 Apr. 127(1):60-5. [QxMD MEDLINE Link].
Wright PA, Lemoine NR, Mayall ES, et al. Papillary and follicular thyroid carcinomas show a different pattern of ras oncogene mutation. Br J Cancer. 1989 Oct. 60(4):576-7. [QxMD MEDLINE Link].
Karga H, Lee JK, Vickery AL Jr, Thor A, Gaz RD, Jameson JL. Ras oncogene mutations in benign and malignant thyroid neoplasms. J Clin Endocrinol Metab. 1991 Oct. 73(4):832-6. [QxMD MEDLINE Link].
Williams MD, Zhang L, Elliott DD, et al. Differential gene expression profiling of aggressive and nonaggressive follicular carcinomas. Hum Pathol. 2011 Sep. 42(9):1213-20. [QxMD MEDLINE Link]. [Full Text].
Williams ED, Abrosimov A, Bogdanova T, et al. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer. 2004 Jun 1. 90(11):2219-24. [QxMD MEDLINE Link].
Zengi A, Karadeniz M, Erdogan M, et al. Does chernobyl accident have any effect on thyroid cancers in Turkey? Aretrospective review of thyroid cancers from 1982 to 2006. Endocr J. 2008 May. 55(2):325-30. [QxMD MEDLINE Link].
Cancer Facts & Figures 2022. American Cancer Society. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf. Accessed: June 14, 2022.
European Network of Cancer Registries. ENCR Factsheets: Thyroid Cancer (TC) Factsheet. Available at https://www.encr.eu/sites/default/files/factsheets/ENCR_Factsheet_Thyroid_2017-2.pdf. January 2017; Accessed: November 12, 2021.
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008 Feb 16. 371(9612):569-78. [QxMD MEDLINE Link].
National Cancer Institute. SEER Cancer Stat Facts: Thyroid Cancer. Available at https://seer.cancer.gov/statfacts/html/thyro.html. Accessed: June 13, 2020.
Follicular thyroid carcinoma. Lloyd RV, Osamura RY, Klöppel G, Rosai J, eds. WHO Classification of Tumours of Endocrine Organs. 4th ed. Lyon, France: International Agency for Research on Cancer; 2017. 10: 92-5.
O'Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS. Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. Eur J Surg Oncol. 2011 Feb. 37 (2):181-5. [QxMD MEDLINE Link].
Sun XS, Guevara N, Fakhry N, Sun SR, Marcy PY, Santini J, et al. Place de la radiothérapie externe dans les cancers de la thyroïde [Radiation therapy in thyroid cancer]. Cancer Radiother. 2013. 17(3):233-43. [QxMD MEDLINE Link]. [Full Text].
McHenry CR, Phitayakorn R. Follicular adenoma and carcinoma of the thyroid gland. Oncologist. 2011. 16(5):585-93. [QxMD MEDLINE Link]. [Full Text].
Ríos A, Rodríguez JM, Ferri B, Martínez-Barba E, Torregrosa NM, Parrilla P. Prognostic factors of follicular thyroid carcinoma. Endocrinol Nutr. 2014 Aug 21. [QxMD MEDLINE Link].
Sugino K, Ito K, Nagahama M, et al. Prognosis and prognostic factors for distant metastases and tumor mortality in follicular thyroid carcinoma. Thyroid. 2011 Jul. 21(7):751-7. [QxMD MEDLINE Link].
Sinnott B, Ron E, Schneider AB. Exposing the thyroid to radiation: a review of its current extent, risks, and implications. Endocr Rev. 2010 Oct. 31(5):756-73. [QxMD MEDLINE Link]. [Full Text].
Handkiewcz-Junak D, Banasik T, Kolosza Z, Roskosz J, Kukulska A, Puch Z. Risk of malignant tumors in first-degree relatives of patients with differentiated thyroid cancer -- a hospital based study. Neoplasma. 2006. 53(1):67-72. [QxMD MEDLINE Link].
Howell GM, Hodak SP, Yip L. RAS mutations in thyroid cancer. Oncologist. 2013. 18 (8):926-32. [QxMD MEDLINE Link]. [Full Text].
Xing P, Wu L, Zhang C, et al. Differentiation of benign from malignant thyroid lesions: calculation of the strain ratio on thyroid sonoelastography. J Ultrasound Med. 2011 May. 30(5):663-9. [QxMD MEDLINE Link].
Miyakawa M, Onoda N, Etoh M, et al. Diagnosis of thyroid follicular carcinoma by the vascular pattern and velocimetric parameters using high resolution pulsed and power Doppler ultrasonography. Endocr J. 2005 Apr. 52(2):207-12. [QxMD MEDLINE Link].
Palmedo H, Bucerius J, Joe A, Strunk H, Hortling N, Meyka S. Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management. J Nucl Med. 2006 Apr. 47(4):616-24. [QxMD MEDLINE Link].
[Guideline] Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010 Dec. 20 (12):1341-9. [QxMD MEDLINE Link]. [Full Text].
Hassan A, Khalid M, Riaz S, Nawaz MK, Bashir H. Follicular Thyroid Carcinoma: Disease Response Evaluation Using American Thyroid Association Risk Assessment Guidelines. Eur Thyroid J. 2015 Dec. 4 (4):260-5. [QxMD MEDLINE Link]. [Full Text].
Meadows KM, Amdur RJ, Morris CG, Villaret DB, Mazzaferri EL, Mendenhall WM. External beam radiotherapy for differentiated thyroid cancer. Am J Otolaryngol. 2006 Jan-Feb. 27(1):24-8. [QxMD MEDLINE Link].
Bikas A, Kundra P, Desale S, Mete M, O'Keefe K, Clark BG, et al. Phase 2 clinical trial of sunitinib as adjunctive treatment in patients with advanced differentiated thyroid cancer. Eur J Endocrinol. 2016 Mar. 174 (3):373-80. [QxMD MEDLINE Link].
Asari R, Koperek O, Scheuba C, Riss P, Kaserer K, Hoffmann M, et al. Follicular thyroid carcinoma in an iodine-replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial. Ann Surg. 2009 Jun. 249(6):1023-31. [QxMD MEDLINE Link].
Spinelli C, Rallo L, Morganti R, Mazzotti V, Inserra A, Cecchetto G, et al. Surgical management of follicular thyroid carcinoma in children and adolescents: A study of 30 cases. J Pediatr Surg. 2018 May 29. [QxMD MEDLINE Link].
Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Tuttle RM, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012 Apr. 151(4):571-9. [QxMD MEDLINE Link].
Tucker N, Mitchem J, Gillanders W. Minimally invasive surgical techniques in the management of differentiated thyroid cancer. Otorinolaringologia. 2013 Jun. 63 (2):53-61. [QxMD MEDLINE Link]. [Full Text].
Lee S, Ryu HR, Park JH, et al. Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg. 2011 Jun. 253(6):1060-6. [QxMD MEDLINE Link].
Jackson NR, Yao L, Tufano RP, Kandil EH. Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck. 2014 Jan. 36 (1):137-43. [QxMD MEDLINE Link].
Carling T, Udelsman R. Thyroid Tumors. DeVita VT Jr, Lawrence TS, Rosenberg SA. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 9th. Philadelphia: Lippincott Williams & Wilkins; 2011. 1457-1472.
Huang SC, Wu VC, Lin SY, Sheu WH, Song YM, Lin YH, et al. Factors related to clinical hypothyroid severity in thyroid cancer patients after thyroid hormone withdrawal. Thyroid. 2009 Jan. 19(1):13-20. [QxMD MEDLINE Link].
Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med. 2012 May 3. 366(18):1674-85. [QxMD MEDLINE Link].
Brassard M, Borget I, Edet-Sanson A, et al. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab. 2011 May. 96(5):1352-9. [QxMD MEDLINE Link].
Sisson JC, Freitas J, McDougall IR, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. 2011 Apr. 21(4):335-46. [QxMD MEDLINE Link].
[Guideline] Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan. 26 (1):1-133. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019 Dec 1. 30 (12):1856-1883. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract. 2016 May. 22 (5):622-39. [QxMD MEDLINE Link]. [Full Text].
Bos JL. ras oncogenes in human cancer: a review. Cancer Res. 1989 Sep. 49(17):4682-9. [QxMD MEDLINE Link].
[Guideline] Haugen BR, Sawka AM, Alexander EK, Bible KC, Caturegli P, Doherty GM, et al. American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid. 2017 Apr. 27 (4):481-483. [QxMD MEDLINE Link].
Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009 Nov. 19 (11):1159-65. [QxMD MEDLINE Link].
McCabe CJ. Moving towards the use of targeted therapies in thyroid cancer. Nat Clin Pract Endocrinol Metab. 2008 Nov. 4(11):604-5. [QxMD MEDLINE Link].
Ito Y, Uramoto H, Funa K, Yoshida H, Jikuzono T, Asahi S. Delta Np73 expression in thyroid neoplasms originating from follicular cells. Pathology. 2006 Jun. 38(3):205-9. [QxMD MEDLINE Link].
Hari CK, Kumar M, Abo-Khatwa MM, Adams-Williams J, Zeitoun H. Follicular variant of papillary carcinoma arising from lingual thyroid. Ear Nose Throat J. 2009 Jun. 88(6):[QxMD MEDLINE Link].
Arnaldi LA, Borra RC, Maciel RM, Cerutti JM. Gene expression profiles reveal that DCN, DIO1, and DIO2 are underexpressed in benign and malignant thyroid tumors. Thyroid. 2005 Mar. 15(3):210-21. [QxMD MEDLINE Link].
Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today andtomorrow. Best Pract Res Clin Endocrinol Metab. 2008 Dec. 22(6):929-39. [QxMD MEDLINE Link].
Cameselle-Teijeiro J, Pardal F, Eloy C, Ruiz-Ponte C, Celestino R, Castro P, et al. Follicular thyroid carcinoma with an unusual glomeruloid pattern of growth. Hum Pathol. 2008 Oct. 39(10):1540-7. [QxMD MEDLINE Link].
Castro P, Eknaes M, Teixeira MR, et al. Adenomas and follicular carcinomas of the thyroid display two major patterns of chromosomal changes. J Pathol. 2005 Jul. 206(3):305-11. [QxMD MEDLINE Link].
Chao TC, Lin JD, Chen MF. Surgical treatment of thyroid cancers with concurrent graves disease. Ann Surg Oncol. 2004 Apr. 11(4):407-12. [QxMD MEDLINE Link].
Clark JR, Lai P, Hall F, et al. Variables predicting distant metastases in thyroid cancer. Laryngoscope. 2005 Apr. 115(4):661-7. [QxMD MEDLINE Link].
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006 Feb. 16(2):109-42. [QxMD MEDLINE Link].
D'Avanzo A, Treseler P, Ituarte PH, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer. 2004 Mar 15. 100(6):1123-9. [QxMD MEDLINE Link].
Di Cristofaro J, Marcy M, Vasko V, Sebag F, Fakhry N, Wynford-Thomas D. Molecular genetic study comparing follicular variant versus classic papillary thyroid carcinomas: association of N-ras mutation in codon 61 with follicular variant. Hum Pathol. 2006 Jul. 37(7):824-30. [QxMD MEDLINE Link].
Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006 Aug. 91(8):2892-9. [QxMD MEDLINE Link].
Eszlinger M, Krohn K, Kukulska A, et al. Perspectives and limitations of microarray-based gene expression profiling of thyroid tumors. Endocr Rev. 2007. 28(3):322-38. [QxMD MEDLINE Link].
Faquin WC. The thyroid gland: recurring problems in histologic and cytologic evaluation. Arch Pathol Lab Med. 2008 Apr. 132(4):622-32. [QxMD MEDLINE Link].
Farahati J, Geling M, Mader U, et al. Changing trends of incidence and prognosis of thyroid carcinoma in lower Franconia, Germany, from 1981-1995. Thyroid. 2004 Feb. 14(2):141-7. [QxMD MEDLINE Link].
Fernandes JK, Day TA, Richardson MS, Sharma AK. Overview of the management of differentiated thyroid cancer. Curr Treat Options Oncol. 2005 Jan. 6(1):47-57. [QxMD MEDLINE Link].
Fryknäs M, Wickenberg-Bolin U, Göransson H, Gustafsson MG, Foukakis T, Lee JJ. Molecular markers for discrimination of benign and malignant follicular thyroid tumors. Tumour Biol. 2006. 27(4):211-20. [QxMD MEDLINE Link].
Giorgadze TA, Baloch ZW, Pasha T, Zhang PJ, Livolsi VA. Lymphatic and blood vessel density in the follicular patterned lesions of thyroid. Mod Pathol. 2005 Nov. 18(11):1424-31. [QxMD MEDLINE Link].
Gosnell JE, Sackett WR, Sidhu S, et al. Minimal access thyroid surgery: technique and report of the first 25 cases. ANZ J Surg. 2004 May. 74(5):330-4. [QxMD MEDLINE Link].
Gyory F, Balazs G, Nagy EV. Differentiated thyroid cancer and outcome in iodine deficiency. Eur J Surg Oncol. 2004 Apr. 30(3):325-31. [QxMD MEDLINE Link].
Hall P, Adami HO. Thyroid Cancer. Adami HO, Hunter D, Trichopoulos D. eds. Textbook of Cancer Epidemiology. 2nd edition. Oxford University Press; 2008. 504-519.
Ilias I, Alevizaki M, Lakka-Papadodima E, Koutras DA. Differentiated thyroid cancer in Greece: 1963-2000. Relation to demographic andenvironmental factors. Hormones. 2002 Jul-Sep. 1(3):174-8. [QxMD MEDLINE Link].
Kaya H, Barbaros U, Erbil Y, Bozbora A, Kapran Y, Aral F, et al. Metastatic thyroid carcinoma. N Z Med J. 2005 Oct 28. 118(1224):U1705. [QxMD MEDLINE Link].
Kebebew E, Clark OH. Differentiated thyroid cancer: "complete" rational approach. World J Surg. 2000 Aug. 24(8):942-51. [QxMD MEDLINE Link].
Kondo T, Ezzat S, Asa SL. Pathogenetic mechanisms in thyroid follicular-cell neoplasia. Nat Rev Cancer. 2006 Apr. 6(4):292-306. [QxMD MEDLINE Link].
Kuijt WJ, Huang SA. Children with differentiated thyroid cancer achieve adequate hyperthyrotropinemia within 14 days of levothyroxine withdrawal. J Clin Endocrinol Metab. 2005 Nov. 90(11):6123-5. [QxMD MEDLINE Link].
Kushwaha RA, Verma SK, Mahajan SV. Endobronchial metastasis of follicular thyroid carcinoma presenting as hemoptysis: a case report. J Cancer Res Ther. 2008. (1):44-5. [QxMD MEDLINE Link].
Lerma E, Mora J. Telomerase activity in "suspicious" thyroid cytology. Cancer. 2005 Dec 25. 105(6):492-7. [QxMD MEDLINE Link].
Lin JD, Chao TC. Follicular thyroid carcinoma: From diagnosis to treatment. Endocr J. 2006 Aug. 53(4):441-8. [QxMD MEDLINE Link].
Mazzaferri EL, Robbins RJ, Spencer CA, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003 Apr. 88(4):1433-41. [QxMD MEDLINE Link].
Muresan MM, Olivier P, Leclère J, et al. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008 Mar. 15(1):37-49. [QxMD MEDLINE Link].
Ogawa Y, Sugawara T, Seki H, Sakuma T. Thyroid follicular carcinoma metastasized to the lung, skull, and brain 12 years after initial treatment for thyroid gland--case report. Neurol Med Chir (Tokyo). 2006 Jun. 46(6):302-5. [QxMD MEDLINE Link].
Pacini F, Schlumberger M, Harmer C, Berg GG, Cohen O, Duntas L. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005 Nov. 153(5):651-9. [QxMD MEDLINE Link].
Reiners C, Farahati J. 131I therapy of thyroid cancer patients. Q J Nucl Med. 1999 Dec. 43(4):324-35. [QxMD MEDLINE Link].
Riesco-Eizaguirre G, Santisteban P. New insights in thyroid follicular cell biology and its impact in thyroid cancer therapy. Endocr Relat Cancer. 2007 Dec. 14(4):957-77. [QxMD MEDLINE Link].
Robbins RJ, Wan Q, Grewal RK, Reibke R, Gonen M, Strauss HW, et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006 Feb. 91(2):498-505. [QxMD MEDLINE Link].
Ronckers CM, McCarron P, Engels EA, Ron E. New Malignancies Following Cancer of the Thyroid and Other Endocrine Glands. Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. Bethesda, MD: NIH Publ. No. 05-5302; 2006. 375-395. [Full Text].
Ruschenburg I, Vollheim B, Stachura J, Cordon-Cardo C, Korabiowska M. Analysis of DNA mismatch repair gene expression and mutations in thyroid tumours. Anticancer Res. 2006 May-Jun. 26(3A):2107-12. [QxMD MEDLINE Link].
Sarquis MS, Weber F, Shen L, et al. High frequency of loss of heterozygosity in imprinted, compared with nonimprinted, genomic regions in follicular thyroid carcinomas and atypical adenomas. J Clin Endocrinol Metab. 2006. 91:262-9. [QxMD MEDLINE Link]. [Full Text].
Savin S, Cvejic D, Isic T, Paunovic I, Tatic S, Havelka M. The efficacy of the thyroid peroxidase marker for distinguishing follicular thyroid carcinoma from follicular adenoma. Exp Oncol. 2006 Mar. 28(1):70-4. [QxMD MEDLINE Link].
Schmitt TS, Elte JW, Rietveld AP, van Zaanen HC, Castro Cabezas M. Bone metastasis of a follicular thyroid carcinoma originated in a toxic multinodular goiter. Eur J Intern Med. 2008 Nov. 19(7):e64-6. [QxMD MEDLINE Link].
Siassakos D, Gourgiotis S, Moustafellos P, et al. Thyroid microcarcinoma during thyroidectomy. Singapore Med J. 2008 Jan. 49(1):23-5. [QxMD MEDLINE Link].
Suster S. Thyroid tumors with a follicular growth pattern: problems in differential diagnosis. Arch Pathol Lab Med. 2006 Jul. 130(7):984-8. [QxMD MEDLINE Link].
Ulger Z, Karaman N, Piskinpasa SV, Niksarlioglu YO, Kilickap S, Erman M. Endobronchial metastasis of thyroid follicular carcinoma. J Natl Med Assoc. 2006 May. 98(5):803-6. [QxMD MEDLINE Link].
Vasko VV, Gaudart J, Allasia C, et al. Thyroid follicular adenomas may display features of follicular carcinoma and follicular variant of papillary carcinoma. Eur J Endocrinol. 2004 Dec. 151(6):779-86. [QxMD MEDLINE Link].
Brandler TC, Zhou F, Liu CZ, Cho M, Lau RP, Simsir A, et al. Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration?. Cancer. 2017 Jun. 125 (6):378-388. [QxMD MEDLINE Link].
Howell GM, Hodak SP, Yip L. RAS mutations in thyroid cancer. Oncologist. 2013. 18 (8):926-32. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Follicular thyroid carcinoma. Surgical specimen of a large goiter. Total thyroidectomy was performed because of the presence of a solid nodule in the right lobe (note the size of the thyroid lobe at left of the screen).
Follicular thyroid carcinoma. The right lobe of the thyroid was sectioned and reveals a large solid nodule with necrotic and hemorrhagic areas. Histologic diagnosis is follicular thyroid carcinoma.
Follicular thyroid carcinoma. Histologic pattern of a mildly differentiated follicular thyroid carcinoma (250 X). Image courtesy of Professor Pantaleo Bufo at University of Foggia, Italy.
Follicular thyroid carcinoma. Histologic pattern of a rare lymph node metastasis of follicular thyroid carcinoma (140 X). Image courtesy of Professor Pantaleo Bufo at University of Foggia, Italy.
Follicular thyroid carcinoma. Histologic pattern of a rare lymph node metastasis of follicular thyroid carcinoma (250 X). Image courtesy of Professor Pantaleo Bufo at University of Foggia, Italy.

of 5

Author

Luigi Santacroce, MD Assistant Professor, Medical School, State University at Bari, Italy

Disclosure: Nothing to disclose.

Coauthor(s)

Lodovico Balducci, MD Professor, Oncology Fellowship Director, Department of Internal Medicine, Division of Adult Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine

Lodovico Balducci, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians, American Geriatrics Society, American Society of Hematology, New York Academy of Sciences, American Society of Clinical Oncology, Southern Society for Clinical Investigation, International Society for Experimental Hematology, American Federation for Clinical Research, American Society of Breast Disease

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Benjamin Movsas, MD

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, American Society for Radiation Oncology

Disclosure: Nothing to disclose.

Chief Editor

Neerav Goyal, MD, MPH, FACS Associate Professor of Otolaryngology-Head and Neck Surgery, Neurosurgery, Public Health Sciences, and Surgery, Chief, Division of Head and Neck Oncology and Surgery, Pennsylvania State University College of Medicine; Associate Director, Skull Base and Pituitary Center, Department of Otolaryngology-Head and Neck Surgery, Penn State Health, Milton S Hershey Medical Center, Penn State Cancer Institute

Neerav Goyal, MD, MPH, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, Hobart Amory Hare Honor Society, North American Skull Base Society, Pennsylvania Academy of Otolaryngology-Head and Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Received research grant from: Medrobotics, Inc; Synthes, Inc, LivaNova.

Additional Contributors

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Kayla Krause, BA MD Candidate, Pennsylvania State University College of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Silvia Gagliardi, MD Consulting Staff, Department of Surgery, Medical Center Vita, Italy

Disclosure: Nothing to disclose.