Diagnosis and therapy of malignant struma

Therapy of malignant struma today nearly always means a combination therapy where surgical measures are combined with external radiation exposure, 131I-therapy, and polychemotherapy depending on histology, TNM stage, and other findings. In metastasing and advanced malignant growths of the thyroid, radical surgical resection of the tumour should be attempted; also, the resulting hyperthyroidism can improve the success of radioiodine treatment. In rare cases, external radiotherapy is applied pre-operatively to reduce the size of inoperable malignant growths, but most often post-operatively to irradiate the lymph ducts and, last but not least, for the irradiation of metastases that do not accumulate 131I and inoperable primary tumours. 131I therapy is advisable for the elimination of thyroid residues after resection of the thyroid in patiens over 40 or in case of metastases as well as for selective internal irradiation of 131I-accumulating metastases of thyroid carcinomas. Last of all, cytostatic treatment is applied in those cases where surgical treatment, external radiotherapy, or 131I therapy have been impossible or unsuccessful. (orig./AJ)