Follicular adenocarcinoma
A primary malignancy of the thyroid gland arising from the thyroid epithelium.
Approximately 20% of cases of thyroid malignancies.
Middle age
F > M
Typically presents as a solitary thyroid nodule in middle-aged patients.
Patients are investigated as for a solitary thyroid nodule. Isotope scanning of the nodule reveals it to be non-functioning or ‘cold’. Definitive diagnosis requires tissue from fine needle aspiration.
Predominantly haematogenous spread. Twenty per cent of patients have metastases in the lungs, bone or liver.
Resembles a benign solitary thyroid nodule, a round encapsulated mass, but less colloid and more solid in appearance. Histology reveals invasion of the capsule, blood vessels and surrounding gland.
Total thyroidectomy with preservation of the parathyroids is required. All palpable lymph nodes are removed. If these contain tumour, a modified radical neck dissection is required. A postoperative radioisotope scan of the skeleton and neck detects metastases as ‘hot spots’, and further treatment is with radioiodine. Thyroxine is given to suppress TSH secretion, as well as for replacement.
Follicular carcinoma is more aggressive than papillary carcinoma. Ten year survival is 50%. Plasma thyroglobulin levels can be monitored for recurrence.
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