Neoplasm of the Thyroid Gland

Thyroid disorders in elderly: A comprehensive review

The approach to management of thyroid disorders in the elderly differs from that for younger individuals: it considers frailty of the population, coexisting medical illness and medications, clearance rate of medications and drug-drug interactions along with target organ sensitivity to the treatment. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of thyroid disorders in the elderly.

Incidental versus clinically diagnosed differentiated thyroid cancer in both adult and elderly subjects: histological characteristics and follow-up in a retrospective analysis from a single institution

PURPOSE

Most thyroid cancer are incidentally diagnosed. However, little is known on the different modalities of incidental diagnosis in adult versus older patients.

METHODS

We retrospectively analyzed data from 440 patients consecutively diagnosed with differentiated thyroid cancer (DTC) in a single institution. Modalities of diagnosis were categorized as follows: (A) clinically diagnosed, nonincidental cases; (B) incidental during carotid power-duplex (CPD); (C) incidental during neck imaging other than carotid power-duplex; (D) incidental during imaging workup of thyroid dysfunction or at histological examination after thyroidectomy for benign lesions. Demographics, histology and follow-up were compared between adult (<65 years) and older (≥65 years) patients according to the different modalities of diagnosis.

RESULTS

A total of 363 and 67 cases were recorded in adult and older patients, respectively with incidental proportions of 79% and 85%, respectively. A P < 0.001 significant difference in the modality of diagnosis was found between adult and older subjects, the latter presenting with a higher prevalence of Group B. In the nonincidental group, papillary histotype, larger size, and extrathyroidal invasion were more frequently observed in older subjects. Disease-free survival was comparable between adult and older subjects in the incidental cases, whereas it was reduced, though not significantly, in older subjects.

CONCLUSION

Incidental cases of DTC are more frequently diagnosed in the old subjects and are mainly due to CPD. Disease-free survival is comparable between adult and older subjects in both incidental and nonincidental cases, although it may be slightly reduced in nonincidentally diagnosed older patients.

Thyroid surgery in the elderly: a comparative experience of 400 patients from an Italian university hospital

The aim of this study was to compare disease features and surgical complications of patients undergoing surgery under or over 65 years of age. We performed a retrospective review of patients undergoing thyroidectomy or lobectomy from January 1990 through January 2012 in our Institution. Patients aged over 65 years of age were compared with younger patients on a 1:1 ratio. A total of 2012 patients were operated on during the study period. Two-hundred patients aged > 65 years were compared with 200 patients < 65 years old. In this series, no significant differences were observed concerning surgical complications between groups. At multivariate analysis, masses causing compression, extended approaches and malignant lesions were significant predictors of complications, irrespective of age. Due to longer life expectancy, elderly patients are being operated on more frequently. Safety of thyroid surgery in this population is still debated. We observed no difference in surgical outcomes between elderly and younger patients; however, some features of the diseases impair survival in the former. Age did not increase likeliness of worse outcomes in patients receiving thyroid surgery.

Approach to and treatment of thyroid disorders in the elderly

Thyroid gland dysfunction is prevalent in older adults and may be associated with significant morbidity if misdiagnosed and left untreated. Because of a decreased number of symptoms at presentation, an increased susceptibility to adverse events if not treated, and a greater likelihood of harm from treatment, the diagnosis and management of thyroid disorders in older adults can be challenging. This review focuses on the epidemiology, clinical presentation, risks and complications, and management of thyroid disorders in older adults, including hyperthyroidism, hypothyroidism, thyroid nodules, and thyroid cancer.

Thyroid cancer in older men

This article reviews most common types of thyroid cancer focusing on older males worldwide. Thyroid carcinoma is the most common endocrine malignancy. It includes tumour types that range from localised papillary carcinomas to lethal anaplastic disease. Among elderly population, male gender seems to be highly correlated with the risk and aggressiveness of thyroid cancer. Early diagnosis and urgent aggressive treatment are important for aging patients. This article includes numerous studies which evaluate prevalence, morbidity and mortality of thyroid cancer in older males.

Aspectos moleculares do câncer tiroideano

A proliferação da célula tiroideana normal é regulada por fatores de crescimento estimuladores e inibidores, que atuam através de seus receptores de membrana e, subseqüentemente, através de transdutores citoplasmáticos. Na glândula normal adulta, o equilíbrio de sinais é tal que a proliferação é mínima, enquanto nas neoplasias o crescimento resulta de um distúrbio irreversível desse equilíbrio. Apesar do número de moléculas envolvidas nesse processo ser grande, apenas um pequeno subgrupo parece estar envolvido na tumorigênese tiroideana. Tais proteínas são codificadas pelos genes RAS, RET, NTRK1 e TP53. O transdutor de sinais ras é ativado por mutações em ponto e constitui uma alteração genética precoce nos tumores com histologia folicular. Os genes dos receptores de crescimento RET e NTRK1 são alterados por rearranjos cromossômicos do tipo translocação ou inversão nos carcinomas papilares e por mutações em ponto nos medulares. As alterações do gene TP53, por sua vez, têm sido observadas em carcinomas tiroideanos pobremente diferenciados e na maioria dos indiferenciados, o que sugere sua participação na progressão dessas lesões. O modelo molecular da carcinogênese tiroideana, embora ainda incompleto, pode fornecer instrumentos importantes para o diagnóstico diferencial e para o desenvolvimento de novas técnicas terapêuticas nesse grupo de neoplasias.