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Chapter: Basic & Clinical Pharmacology : Thyroid &Antithyroid Drugs

Thyroid Neoplasms

Neoplasms of the thyroid gland may be benign (adenomas) or malignant.

THYROID NEOPLASMS

Neoplasms of the thyroid gland may be benign (adenomas) or malignant. The primary diagnostic test is a fine needle aspiration biopsy and cytologic examination. Benign lesions may be moni-tored for growth or symptoms of local obstruction, which would mandate surgical excision. Levothyroxine therapy is not recom-mended for the suppression of benign nodules, especially in iodine sufficient areas. Management of thyroid carcinoma requires a total thyroidectomy, postoperative radioiodine therapy in selected instances, and lifetime replacement with levothyroxine. The evalu-ation for recurrence of some thyroid malignancies often involves withdrawal of thyroxine replacement for 4–6 weeks—accompanied by the development of hypothyroidism. Tumor recurrence is likely if there is a rise in serum thyroglobulin (ie, a tumor marker) or a positive 131I scan when TSH is elevated. Alternatively, administra-tion of recombinant human TSH (Thyrogen) can produce com-parable TSH elevations without discontinuing thyroxine and avoiding hypothyroidism. Recombinant human TSH is adminis-tered intramuscularly once daily for 2 days. A rise in serum thyro-globulin or a positive 131I scan will indicate a recurrence of the thyroid cancer.


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Basic & Clinical Pharmacology : Thyroid &Antithyroid Drugs : Thyroid Neoplasms |


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