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 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 S 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, andpropylthiouracil) – prevent hormone synthesis Iodinated contrast agents (Iopanoic acid oripodate 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 inintrathyroidal capillary carcinoma <2cmand no history of neck irradiation Follow with suppressive therapy withthyroid hormone up to TSHconcentration of <0.1 microunit per mL Ferri, F.F. (2002) Ferri’s Clinical Advisory. USA: Mosby, Inc.