Thyroid carcinoma is the most common endocrine maligancy, and the worldwide incidence has been rising in recent years. Differentiated thyroid carcinoma is the most common thyroid malignancy, which include thyroid papillary carcinoma and follicular thyroid carcinoma, accounting for about 90 percent of thyroid carcinoma incidence. Currently, surgical treatment, iodine radiotherapy and TSH suppressive therapy are the commonly accepted effective treatments for differentiated thyroid carcinoma, and most patients can be cured. But there are still some patients not sensitive to the general treatments, who have lost the treatment of opportunity. Molecular targeted therapy is an agonistic or suppressive treatment for molecular biology targets of malignant tumor, and currently is a frontier research in the field of malignancy treatment. By retrieving and analyzing the related literature of molecular targeted therapy of thyroid carcinoma through PUBMED in the past 5 years, the article introduced the current status of molecular targeted therapy of thyroid carcinoma.
Adenocarcinoma, Follicular ; drug therapy ; Carcinoma ; drug therapy ; Carcinoma, Papillary ; Humans ; Molecular Targeted Therapy ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; drug therapy

BACKGROUND AND OBJECTIVES: Anaplastic carcinoma of thyroid gland is a lethal entity: few patients live more than 12 months following the diagnosis. We retrospectively reviewed the experience with this entity at our institute with respect to prognostic factors influencing survival. MATERIALS AND METHODS: Thirteen cases of anaplastic carcinoma of thyroid gland diagonsed from 1995 to 2000 were analyzed retrospectively. The median age at presentation was 66.2 years; the male/female ratio was 1.17:1: and the most common symptom was a rapidly enlarging neck mass. RESULTS: All but one patient died within one year of diagnosis. Tumor size of less than 7 cm and complete resection of tumor were significant prognostic factors. Patients who had operation with or without radiotherapy and/or chemotherapy survived significantly longer than other patients. Median survival duration was 74 days. CONCLUSION: This study showed that complete resection and multimodal treatment for tumor of size less than 7 cm resulted in prolonged survival for a subgroup of patients with anaplastic thyroid carcinoma.
Carcinoma* ; Combined Modality Therapy ; Diagnosis ; Drug Therapy ; Humans ; Neck ; Radiotherapy ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms

Synthetic thyroxine has replaced animal thyroid gland extract as the preferred drug in chronic thyroid hormone replacement. Synthetic thyroxine monotherapy is used to treat overt primary and secondary hypothyroidism, and some cases of subclinical hypothyroidism. In addition, thyroid-stimulating hormone suppressive therapy with thyroxine is a component of the chronic treatment for differentiated thyroid carcinoma. Liothyronine, however, is conventionally for short-term usage, including thyroid hormone withdrawal preparation for radioactive iodine scanning and treatment of differentiated thyroid carcinoma and some cases of myxoedema coma. On very rare occasions where patients are apparently intolerant of or unresponsive to thyroxine, liothyronine may be used chronically. However, there is controversy concerning the use of alternative regimens of thyroid hormone, such as the use of thyroxine-liothyronine combination and thyroid extracts. Thyroid hormone has also been misused to promote weight loss and treat 'symptomatic' biochemically euthyroid patients. There is insufficient evidence to support the use of thyroid hormone to improve treatment response in depression and severe non-thyroidal illnesses.
Animals ; Depression ; drug therapy ; Hormone Replacement Therapy ; adverse effects ; methods ; Humans ; Hypothyroidism ; drug therapy ; Thyroid Function Tests ; Thyroid Hormones ; adverse effects ; therapeutic use ; Thyroid Neoplasms ; drug therapy

Differentiated thyroid cancer of follicular cell origin (DTC) is a fascinating tumor because of its varying aggressiveness. Luckily most patients with these cancers, despite regional metastasis, can be cured by surgical resection, radioiodine ablation and thyrotropin (TSH) suppression therapy. Unfortunately some patients with well differentiated thyroid cancer that fail to respond to conventional treatment and also patients with poorly differentiated thyroid cancers or anaplastic thyroid cancers are not successfully treated by this combined therapy. These tumors unfortunately may grow rapidly, invade adjacent structures and spread to other parts of the body. During the dedifferentiation process, these carcinomas lose thyroid specific gene expressions including the ability to take up and organify radioiodine and to make thyroglobulin (Tg). The methods used to treat patients with DTC are therefore usually not effective in these patients. These tumors also usually fail to respond to alternative treatment with external radiation or systemic cancer chemotherapy. We therefore need to develop new treatments for these unfortunate patients. Recent advances in molecular and cellular biology make it possible to develop new therapeutic approaches to thyroid cancer. Genes related with thyroid specific functions are also promising targets for cancer therapy. Redifferentiation therapy targets thyroid specific genes in order to restore thyroid specific differentiated function and thus to make these tumors respond to conventional therapy. Redifferentiating agents and gene therapy using thyroid specific genes have been studied for this purpose. Most of therapeutic approaches described here have been established effects in vitro but have not yet been used clinically. Careful clinical trials and analyses should be performed.
Drug Therapy ; Gene Expression ; Genetic Therapy ; Humans ; In Vitro Techniques ; Neoplasm Metastasis ; Thyroglobulin ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin

The columnar cell variant of papillary thyroid carcinoma is an aggressive tumor associated with wide spread dissemination and a fatal outcome. We report two cases of columnar cell carcinoma occurring in two women aged 27, 66 years, respectively. The histologic feature of both cases showed focal papillary growth with columnar cell and nuclear stratification. Recognizing the columnar cell variant of the thyroid is important in light of the aggressive nature of the lesion and its apparent resistance to standard therapeutic interventions. These tumors occur over a wide age range, can metastasize widely, and are not usually responsive to radioactive iodine or chemotherapy. The presence or absence of extrathyroidal invasion represents the single most important parameter in predicting the behavior of these tumors. A large series of these tumors is needed to more fully appreciate the clinicopathologic spectrum of this aggressive thyroid neoplasm.
Drug Therapy ; Fatal Outcome ; Female ; Humans ; Iodine ; Thyroid Gland* ; Thyroid Neoplasms*

Medullary thyroid cancer (MTC) accounts for 5% to 10% of all thyroid cancers, and originates from the parafollicular or C-cells of the thyroid gland. More than 50% of patients present with a thyroid mass and up to 75% of these patients have locoregional lymph node metastasis at the time of diagnosis. The neuroendocrine C-cells of the thyroid gland secrete calcitonin, a relatively accurate tumor marker for MTC. Plasma basal and stimulated calcitonin measurements have been used to screen patients who are at risk of developing MTC and indispensable for the detection of residual MTC after initial surgical treatment. The overall survival rate of patients with MTC is intermediate to that of patients with differentiated thyroid cancer and anaplastic thyroid cancer. Postoperative radioiodine ablation therapy, chemotherapy and radiation therapy are generally ineffective. Surgical resection, therefore, remains the only definite treatment for patients with MTC. Unfortunately, residual MTC as indicated by elevated plasma basal or stimulated calcitonin levels is common even after apparent complete initial surgical resection. We present a case of metastatic MTC in the anterior mediastinum with review of the literatures.
Calcitonin ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Mediastinum* ; Neoplasm Metastasis ; Plasma ; Survival Rate ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms*

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

We report on five cases of skin metastasis according to the breast cancer (BC) subtype. Two cases of HER2 positive BC showed only skin metastasis after immediate postoperative period and rapid clinical response to targeted therapy. Another two cases of triple negative BC showed thyroid and lung metastasis in addition to skin metastasis, and their response of cytotoxic chemotherapy was not definite. The other hormone positive BC showed skin metastasis only, with a longer, slower, less progressive pattern than other subtypes. Most cases of skin metastasis were detected at terminal stage of malignancy and were considered to have a limited survival period. However, some BC patients can survive longer if the targeted agents are effective. Therefore, physicians should provide detailed follow up of BC after curative treatment and understand the metastatic pattern of BC according to the subtype.
Breast Neoplasms* ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis* ; Postoperative Period ; Skin Neoplasms ; Skin* ; Thyroid Gland

Malignant lymphoma of the thyroid gland is extremely rare and its relatedness to Hashimoto's thyroiditis is well documented. Thyroid lymphoma frequently compromises the upper aerodigestive tract and should be differenciated from the anaplastic thyroid carcinoma. Also, thyroid lymphoma is known to often recur in the gastrointestinal tract. Recently we have experienced a case of B cell immunoblastic type, non-Hodgkin's malignant lymphoma of the thyroid gland in a 61 year-old male patient. The case presented a rapidly growing mass with dyspnea at the anterior neck, and an open biopsy with tracheostomy was carried out. The patient received a combination chemotherapy and a partial remission was observed.
Biopsy ; Drug Therapy, Combination ; Dyspnea ; Gastrointestinal Tract ; Humans ; Lymphoma* ; Male ; Middle Aged ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroiditis ; Tracheostomy