THYROIDAND
PARATHYROIDDISEASES–
NEWINSIGHTSINTO
SOMEOLDAND
SOMENEWISSUES
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EditedbyLauraSterianWard
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Thyroid and Parathyroid Diseases –
New Insights into Some Old and Some New Issues
Edited by Laura Sterian Ward


Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech
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First published March, 2012
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from

Thyroid and Parathyroid Diseases – New Insights into Some Old and Some New Issues,
Edited by Laura Sterian Ward
p. cm.
ISBN 978-953-51-0221-2

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Contents

Preface IX
Part 1 Evaluating the Thyroid Gland and Its Diseases 1
Chapter 1 Introduction to Thyroid:
Anatomy and Functions 3
Evren Bursuk
Chapter 2 The Thyroglobulin:
A Technically Challenging Assay for
a Marker of Choice During the Follow-Up
of Differentiated Thyroid Cancer 23
Anne Charrié
Chapter 3 Papillary Thyroid Microcarcinoma –
Do Classical Staging Systems Need to Be Changed? 33
Carles Zafon
Chapter 4 Thyroid Neoplasm 45
Augusto Taccaliti, Gioia Palmonella,
Francesca Silvetti and Marco Boscaro
Chapter 5 Thyroid Growth Factors 77
Aleksander Konturek and Marcin Barczynski
Chapter 6 Vascular Endothelial Growth Factor (VEGF)
and Epidermal Growth Factor (EGF)
in Papillary Thyroid Cancer 87
Aleksander Konturek and Marcin Barczynski

Chapter 7 Immune Profile and Signal Transduction
of T-Cell Receptor in Autoimmune Thyroid Diseases 95
Adriano Namo Cury
Chapter 8 Estrogen Signaling and Thyrocyte Proliferation 109
Valeria Gabriela Antico Arciuch and Antonio Di Cristofano
VI Contents

Chapter 9 Suspicious Thyroid Fine Needle Aspiration Aspiration Biopsy:
TSH as a Malignancy Marker? 125
Renata Boldrin de Araujo, Célia Regina Nogueira,
Jose Vicente Tagliarini, Emanuel Celice Castilho,
Mariângela de Alencar Marques, Yoshio Kiy,
Lidia R. Carvalho and Gláucia M. F. S. Mazeto
Part 2 Treatment of Thyroid and Parathyroid Diseases 133
Chapter 10 Minimally-Invasive Parathyroid Surgery 135
David Rosen, Joseph Sciarrino and Edmund A. Pribitkin
Chapter 11 Management of Primary Hyperparathyroidism:
‘Past, Present and Future’ 147
Sanoop K. Zachariah
Chapter 12 Treatment Modalities in Thyroid Dysfunction 171
R. King and R.A. Ajjan
Chapter 13 New Technologies in Thyroid Surgery 189
Bahri Çakabay and Ali Çaparlar
Chapter 14 Management of Primary Hyperparathyroidism 203
Jessica Rose

and Marlon A. Guerrero
Chapter 15 Synthetic and Plant Derived Thyroid Hormone Analogs 221
Suzana T. Cunha Lima, Travis L. Merrigan and Edson D. Rodrigues
Part 3 Psychiatric Disturbances Associated to Thyroid Diseases 237

Chapter 16 Thyroid and Parathyroid Diseases
and Psychiatric Disturbance 239
A. Lobo-Escolar, A. Campayo, C.H. Gómez-Biel and A. Lobo
Chapter 17 Depressive Disorders and Thyroid Function 259
A. Verónica Araya, Teresa Massardo, Jenny Fiedler, Luis Risco,
Juan C. Quintana and Claudio Liberman
Chapter 18 Psychosocial Factors in Patients with Thyroid Disease 279
Petra Mandincová



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Preface

Thyroid and para thy roiddiseasesare amongthe most frequent conditions we have to
deal with in a clinical setti ng. Both nodular and autoimmun e  diseases aff ecting these
glands haveincreasedre markablyove rthepast decades.Thewidespreadus eof cross‐
sectional imaging and the introduction of neck ultrasonography have led to
a thyroid
nodule epidem i c s  and the diagnostic of neck lesions in half of the population.
Consequently, many patients with microscopic papillary thyroid cancers of uncertain
clinical significance are submitted to surger i es that  may, perhaps, be unnecessary.
Differentiated thyroidcanceristhe fastes t‐growingcancer inwo men;it increased2.4 %
peryear

during 1980to1997and6.5%peryearduring1997to2006inth e USAaccording
to the National Cancer Instituteʹs Surveillance Epidemiology and End Results (SEER).
Ontheotherhand,therefinementofnewapproa chesforsurveillanceof patientswithan
establisheddiagnosisofthyroid cancerisleading
totheobservat ionthatmanypatients,
pre vious lytho ughttobecured,haveevide nceof minimalresidu aldisease,acondition
withwhichwestilldonotknowhowtomanageproperly .
Evaluating the Thyroid Gland and its Diseases section includes useful information
into the anatomy and functions of the thyroid gland; the
 thyroid neoplasm and its
most challenging type, the papillary thyroid microcarcinoma; the use and technical
peculiarities of thyroglobulin dosages and fine aspiration citology. In addition,
important articles approach basic aspects of thyroid carcinogenesis, namely growth
factors, angiogenesis, and the importance of estrogen signaling on thyrocyte
proliferation.
Theincreaseinautoimmune
thyroiddiseaseshasbeennolessremarkablethanthatof
thyroid nodules, but it is more difficult to document. However, there are evidences
indicating that around 5‐10% of the population suffers from a thyroid dysfunction,
mostlyautoimmunehypothyroidism.AbeautifularticlefromDrCuryexplainstothe
reader how our immune system copes with the modifications associated to
autoimmunethyroiddiseases.
Thyroid disease can affect your mood, causing either anxiety or depression, and a
second section of the book, Psychiatric disturbances associated to thyroid diseases,
groupsthreeveryinterestingarticlesapproachingthepsychiatricdisturbancesandthe
psychosocialaspectsassociatedto
thyroiddiseases.
X Preface

Finally, the third section, Treatment of Thyroid and Parathyroid Diseases, is

designedmostlytotheyoungpractitioner.Infact,thefield ofthyroidandparathyroid
surgeryaswellasthyroiddiseasestreatmentmodalitieshaveundergonerapidchange
in the past few years with the advent of new techniques and the appearing
 of new
basicandclinicalevidences.Also,weneedtounderstandhowhormoneanalogsmay
affectourglandsandaholechapterisdevotedtothissubject.
The burden of thyroid and parathyroid diseases continue to increase and a better
knowledge of these pathologies molecular, epidemiological and clinical behavior is
essentialinordertobettermanageourpatients.
Thyroid and Parathyroid diseases aims to provide meaningful information to the
practitionerthroughtheeyesofthoughleadersinthedisciplinewhohavecontributed
their time and expertise  to this effort. It is not a comprehensive textbook but rater a
carefully chosen collection
 of very important topics written and illustrated inaform
that hopefully will please all, the clinicians, the surgeons, the pathologists, the
radiologistsandallthefansoftheheadandneckdiseases.
Hopeyouenjoyit!
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LauraSterianWard
AssociateProfessorofMedicineattheFacultyofMedicalSciences,
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StateUniversityofCampinas,
Brazil
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Part 1
Evaluating the Thyroid Gland and Its Diseases