For Papillary Carcinoma• Surgical treatment • Radioactive therapy • Hormone therapy • Chemotherapy

• Patient must be euthyroid • Antithyroid drugs:– Methimazole – Carbimazole– Propylthiouracil

• For symptomatic relief of Grave’s disease:– Propranolol

• detect and destroy any metastasis and residual tissue in the thyroid 4-6 weeks after surgical thyroid removal .

• Radioiodine treatment used again 6-12 months after initial treatment of metastatic disease where disease recurs or has not fully responded.

• Thyroid hormone replacement of levothyroxine may be given to patients for life after total thyroidectomy– (levothyroxine at 2.5-3.5 mcg/kg/d) to prevent

hypothyroidism and maintain euthyroid levels

• Cisplatin or Doxorubicin has limited efficacy, producing occasional objective responses (generally for short durations).

• Disadvantage: High toxicity – Considered in symptomatic patients with recurrent or

advancing disease.

• Advantage: Improve the quality of life in patients with bone metastases, – Standard protocol for chemotherapeutic management

has not been developed for these patients.

For Grave’s disease• Symptomatic relief• Thyroid suppression• Surgical treatment

• Propranolol may be used for symptomatic relief of tachycardia, tremors, diaphoresis, and anxiety in these patients.

• Thiourea drugs (methimazole, carbimazole, and propylthiouracil)

• Iodinated contrast agents (Iopanoic acid or ipodate sodium)

• Radioactive iodine

• Hartley-Dunhill operation is the surgical treatment of choice in Grave’s disease– total resection of one lobe and a subtotal resection of

the other lobe leaving about 4grams of thyroid tissue

• Thyroid suppression using Thiourea drugs (methimazole, carbimazole, and propylthiouracil) – prevent hormone synthesis

• Iodinated contrast agents (Iopanoic acid or ipodate sodium) – hasten the decline in serum T3 – reduce thyroid vascularity prior to surgery.

Tierney, L.M. et al. (2006). Current Medical Diagnoisis & treatment 45 th editionNorth America: The McGraw-Hill Companies, Inc..

• Lobectomy with isthmectomy in intrathyroidal capillary carcinoma <2cm and no history of neck irradiation

• Follow with suppressive therapy with thyroid hormone up to TSH concentration of <0.1 microunit per mL

Ferri, F.F. (2002) Ferri’s Clinical Advisory. USA: Mosby, Inc.