Condition Overview
Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer, accounting for about 10-15% of all thyroid cancers. FTC originates from the follicular cells of the thyroid gland, which are responsible for producing and secreting thyroid hormones. FTC is generally slightly more aggressive than papillary thyroid carcinoma (PTC) but still has a favorable prognosis when detected and treated early.
FTC typically presents as a solitary thyroid nodule, which may be palpable in the neck. Unlike PTC, FTC is more likely to spread via the bloodstream to distant organs, particularly the lungs and bones, rather than through the lymphatic system. For that reason, removal of the lymph nodes is not required to the same degree. Symptoms can include a painless lump in the neck, difficulty swallowing (dysphagia), difficulty breathing (dyspnea), hoarseness, and, in advanced cases, symptoms related to metastatic spread such as bone pain or respiratory issues.
Diagnosis involves a combination of clinical evaluation, ultrasound imaging, fine-needle aspiration biopsy (FNAB), and histopathological examination. FTC is often distinguished from benign follicular adenomas by the presence of capsular or vascular invasion, which can only be confirmed through surgical biopsy and histopathological analysis. In other words, FNA biopsies can often not completely diagnose these tumors.
Treatment Options
- Total Thyroidectomy
- Description: Total thyroidectomy involves the complete removal of the thyroid gland. It is the standard treatment for large or invasive Follicular Thyroid Carcinoma (FTC) to ensure all potentially cancerous tissue is removed and to facilitate postoperative radioactive iodine therapy if needed.
- Indications: Confirmed FTC, larger tumors, multifocal disease, presence of capsular or vascular invasion.
- Radioactive Iodine (RAI) Therapy
- Description: RAI therapy involves the oral administration of radioactive iodine to destroy any remaining thyroid tissue or microscopic cancer cells after surgery. This treatment is effective because thyroid cells naturally absorb iodine, and it can be important for cases of follcular thyroid carcinoma that have spread to other body sites.
- Indications: Postoperative adjuvant therapy, metastatic FTC, residual disease, recurrence prevention.
- Thyroid Hormone Suppression Therapy
- Description: This treatment involves administering thyroid hormone to suppress TSH levels, which can stimulate the growth of any remaining thyroid cancer cells. It is often used as an adjunct to other treatments, but should be used cautiously.
- Indications: Postoperative management, prevention of recurrence, patients with residual disease.
- External Beam Radiation Therapy (EBRT)
- Description: EBRT involves targeting the thyroid region or metastatic sites with high-energy radiation to kill cancer cells. This is typically reserved for cases where surgery and RAI are insufficient or not possible.
- Indications: Unresectable tumors, palliative treatment for metastatic disease, recurrence not responsive to RAI.
- Chemotherapy
- Description: Chemotherapy uses drugs to kill cancer cells or slow their growth. It is rarely used for FTC but may be considered in cases of widespread metastatic disease that is not responsive to other treatments. Sometimes, target therapies can be used if a specific mutation is identified.
- Indications: Advanced or refractory FTC, part of a multimodal treatment approach.
Management of FTC requires a multidisciplinary approach involving endocrinologists, surgeons, oncologists, and radiologists. The choice of treatment depends on the tumor's characteristics, the extent of disease, patient preferences, and overall risk assessment. Regular monitoring and follow-up are essential to detect any recurrence or progression and to adjust the management plan as needed. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your follicular thyroid carcinoma.
