best java barcode library Treatment of Differentiated Thyroid Carcinoma in Objective-C

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Treatment of Differentiated Thyroid Carcinoma
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Surgical removal is the treatment of choice for thyroid carcinomas Neck ultrasound is useful both preoperatively and in follow-up For differentiated papillary and follicular carcinoma, thyroidectomy with limited removal of cervical lymph nodes is adequate However, for patients with H rthle cell carcinoma or medullary thyroid carcinoma who have metastases to lymph nodes, modified radical neck dissection is recommended Highly skilled surgeons can perform near-total thyroidectomies with a less than 1% rate of serious complications (hypoparathyroidism or recurrent laryngeal nerve damage) Other series have reported up to an 11% incidence of permanent hypoparathyroidism after total thyroidectomy Thyroidectomy requires at least an overnight hospital admission, since late bleeding, airway problems, and tetany can occur Ambulatory thyroidectomy is potentially dangerous and should not be done The incidence of hypoparathyroidism may be reduced if accidentally resected parathyroids are immediately autotransplanted into the neck muscles The advantage of near-total thyroidectomy for differentiated thyroid carcinoma is that multicentric foci of carcinoma are more apt to be resected and there is then less normal thyroid tissue to compete with cancer for 131I administered later for scans or treatment Subtotal thyroidectomy is acceptable for adults under age 45 years who have a single small tumor ( 1 cm in diameter) Neck muscle dissections are usually avoided for differentiated thyroid carcinoma T4 is prescribed in doses of 005 01 mg/d immediately postoperatively The dosage is adjusted to keep the serum TSH slightly suppressed during long-term follow-up of differentiated thyroid carcinoma About 2 4 months after surgery, a whole-body 131I scan is performed T4 is stopped for 6 weeks prior to the scan, thereby causing hypothyroidism; TSH then rises and stimulates iodide uptake and thyroglobulin release from residual tumor or normal thyroid Iodine-containing foods and contrast media are avoided Metastases to the brain are best treated surgically, since treatment with radiation or RAI is ineffective Patients with bulky recurrent tumor in the neck region also benefit from surgery
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Following total or near-total thyroidectomy, patients with differentiated thyroid carcinoma receive an RAI neck and whole-body scan, either while hypothyroid, or after thyrotropin administration In patients with visible RAI uptake, those with stage II IV cancer should be treated with adjuvant 131I therapy, when possible The use of RAI therapy for patients with stage I differentiated thyroid cancer (with residual thyroid bed RAI uptake) is controversial; there has been no demonstrable improvement in survival in this group of patients following RAI therapy, although RAI therapy reduces the risk of local recurrence Some groups advocate RAI therapy for patients with stage I disease whose primary tumor was over 1 cm in diameter Patients must have demonstrated uptake of RAI on diagnostic scanning to warrant RAI therapy For patients who have 131I therapy, the dose of 131I for thyroid remnant ablation (residual normal thyroid with perhaps thyroid cancer in the thyroid bed) in those with no nodal involvement is 30 100 mCi, with the higher doses given to patients with large primary tumors or tumors at the surgical margin Patients with local lymph node involvement typically receive 100 mCi of 131I; patients with more extensive neck node involvement or distant metastases receive 150 200 mCi of 131I Prior to 131I therapy, patients must be allowed to become hypothyroid, since high TSH levels stimulate thyroid cancer cells to actively absorb more iodine, and hypothyroidism reduces the renal clearance of iodine Being hypothyroid is uncomfortable for most patients Because levothyroxine (T4) has a much longer half-life than T3, the following protocol is suggested to prepare patients for 131I therapy: 8 weeks prior to 131 I therapy, levothyroxine replacement therapy is stopped and T3 (Cytomel) is substituted at a dose of 125 mcg orally twice daily; 6 weeks prior to 131I therapy, the Cytomel is increased to 25 mcg orally twice daily; 16 days prior to 131I therapy, the Cytomel is discontinued
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