THYROIDAND PARATHYROIDDISEASES– NEWINSIGHTSINTO SOMEOLDAND SOMENEWISSUES EditedbyLauraSterianWard 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 All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Ana Skalamera Technical Editor Teodora Smiljanic Cover Designer InTech Design Team 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 orders@intechweb.org 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 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 Preface Thyroid and para thy roiddiseasesare amongthe most frequent conditions we have to deal with in a clinical setti ng. Both nodular and autoimmun e diseases aff ecting these glands haveincreasedre markablyove rthepast decades.Thewidespreadus eof 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 thyroidcanceristhe fastes t‐growingcancer inwo men;it increased2.4 % peryear during 1980to1997and6.5%peryearduring1997to2006inth e USAaccording to the National Cancer Instituteʹs Surveillance Epidemiology and End Results (SEER). Ontheotherhand,therefinementofnewapproa chesforsurveillanceof patientswithan establisheddiagnosisofthyroid cancerisleading totheobservat ionthatmanypatients, pre vious lytho ughttobecured,haveevide nceof minimalresidu aldisease,acondition withwhichwestilldonotknowhowtomanageproperly . 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. Theincreaseinautoimmune thyroiddiseaseshasbeennolessremarkablethanthatof 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, mostlyautoimmunehypothyroidism.AbeautifularticlefromDrCuryexplainstothe reader how our immune system copes with the modifications associated to autoimmunethyroiddiseases. Thyroid disease can affect your mood, causing either anxiety or depression, and a second section of the book, Psychiatric disturbances associated to thyroid diseases, groupsthreeveryinterestingarticlesapproachingthepsychiatricdisturbancesandthe psychosocialaspectsassociatedto thyroiddiseases. X Preface Finally, the third section, Treatment of Thyroid and Parathyroid Diseases, is designedmostlytotheyoungpractitioner.Infact,thefield ofthyroidandparathyroid surgeryaswellasthyroiddiseasestreatmentmodalitieshaveundergonerapidchange in the past few years with the advent of new techniques and the appearing of new basicandclinicalevidences.Also,weneedtounderstandhowhormoneanalogsmay affectourglandsandaholechapterisdevotedtothissubject. The burden of thyroid and parathyroid diseases continue to increase and a better knowledge of these pathologies molecular, epidemiological and clinical behavior is essentialinordertobettermanageourpatients. Thyroid and Parathyroid diseases aims to provide meaningful information to the practitionerthroughtheeyesofthoughleadersinthedisciplinewhohavecontributed 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 inaform that hopefully will please all, the clinicians, the surgeons, the pathologists, the radiologistsandallthefansoftheheadandneckdiseases. Hopeyouenjoyit! LauraSterianWard AssociateProfessorofMedicineattheFacultyofMedicalSciences, StateUniversityofCampinas, Brazil . THYROID AND PARATHYROID DISEASES – NEW INSIGHTS INTO SOME OLD AND SOME NEW ISSUES EditedbyLauraSterianWard Thyroid and Parathyroid Diseases – New Insights into. Larynx Thyroid gland Isthmus Trachea Thyroid and Parathyroid Diseases – New Insights into Some Old and Some New Issues 4 gland is wrapped up by a fibrosis capsule named thyroid. The thyroid. monoiodothyronine, and diiodothyronine Thyroid and Parathyroid Diseases – New Insights into Some Old and Some New Issues 8 4 th stage is the coupling and T 3 and T 4 are synthesized from MIT and DIT