Advances in the diagnosis and management of thyroid neoplasms

Thyroid cancers are still the most common endocrine cancers. They are dominated by well-differentiated carcinomas, including papillary carcinoma, follicular carcinoma, and medullary thyroid carcinoma. Diagnosis is based on fine-needle aspiration cytologic examination. Recently, reverse transcription polymerase chain reaction for the detection of cancer-specific mRNA was shown to be a useful adjunct in both initial diagnosis and detection of recurrent disease. In addition, positron emission tomography has become a valuable tool for staging and surveillance of thyroid cancer. Given the gradual perfection of surgical technique and reduction in complication rates, near-total and total thyroidectomy should be offered to patients with well-differentiated carcinoma. For medullary thyroid carcinoma, near-total and total thyroidectomy with routine central and bilateral functional neck dissection are recommended. So far, no effective treatment exists for anaplastic thyroid carcinoma.