Physiology and Diseases of the Thyroid Gland in the Elderly: Thyroid Cancer

Abstract

Abstract After a brief epidemiological and anatomical-pathological review, the peculiarities of differentiated thyroid carcinoma (DTC) in the elderly are reviewed, including novel aspects such as preoperative staging and indications for diagnostic surgery. The surgical indications for hemithyroidectomy and total thyroidectomy, detailed surgical strategy on lymph node neck dissection, contributions of the sentinel node, and the impact of biological markers for prophylactic central neck indications are also reviewed. We examine the clinical-pathologic and risk staging of DTC, as well as the prognostic factors and the influence of age on prognosis. We have updated the indications for radioiodine, criteria for TSH suppression, and the follow-up of DTC based on serum thyroglobulin and imaging, according to the latest guidelines, paying special attention to older adults. Papillary microcarcinoma is explored in detail with special reference to its active surveillance. Peculiarities of follicular, medullary, and anaplastic cancers, as well as, lymphoma in advanced age are also described.