Goitre and thyroid cancer

Abstract

Goitre is the generic term for thyroid enlargement and encompasses both benign and malignant thyroid disease. As the clinical presentations of benign and malignant thyroid disease are similar, the aim of clinical assessment and investigations is to identify the small number of cancers among the more frequent non-malignant goitres. Key investigations include thyroid function tests, high-resolution ultrasonography and fine-needle aspiration cytology. Benign thyroid disease should require treatment only for dysfunction (i.e. hyperthyroidism), local compressive symptoms or occasionally aesthetic considerations. New non-surgical techniques such as thermal ablation are gathering popularity in selected patients with benign thyroid nodules. The treatment of thyroid cancer is multidisciplinary. For differentiated thyroid cancer it consists primarily of surgery selectively followed by radioiodine therapy and suppression of thyroid-stimulating hormone, with a degree and duration tailored to disease risk. Advanced malignancy and cancers refractory to standard treatment are increasingly managed with novel targeted therapies. In the UK the diagnosis and management of thyroid cancer have been centralized around a multidisciplinary team structure in order to improve outcomes. Recent developments in the management of thyroid cancer include the use of molecular biomarkers to identify malignancy in thyroid nodules, assist with prognostication and facilitate targeted therapy for advanced disease.