Current Guideline of Thyroid Cancer Management

SL-1

Personalized Management of Differentiated Thyroid Cancer: An Update of Guidelines and Literature Review

1Yen-HsIang CHang, 1,2PEI-WEN WANG

Department of 1Nuclear Medicine and 2Internal Medicine, Kohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

In 2009, the American Thyroid Association established the guidelines regarding the management of differentiated thyroid carcinoma (DTC). More new studies have been published since then. According to the new evidences, the treatment of DTC has continued to modify and evolve. Not only guidelines in the US but also the European countries announced the changes in DTC management recently.

We selected clinical questions regarding the management of DTC and revised them based on newly published data from western countries and unpublished ATA guidelines as well.

More data have accumulated about conservative treatment of low-risk patients. In selective cases, observation of low-risk papillary microcarcinoma and lobectomy for low-risk papillary thyroid carcinoma (PTC) has become an acceptable alternative to total thyroidectomy. Thyroidectomy without prophylactic central neck dissection may be appropriate for small (T1 or T2), non-invasive, clinically node-negative PTC.

Post-surgical radioactive iodine (RAI) ablation is almost routinely performed, however, recent studies showed that ablation is not beneficial for survival in low-risk patients. Recombinant human thyroid-stimulating hormone (rhTSH) has been recommended as the first line mode of TSH stimulation except for high risk patients or those with recurrent/metastatic disease. Although low-dose (30mCi) ablation showed similar ablation rate to high-dose ablation, long-term outcome has not yet been established.

According to the follow-up of DTC patients, no single factor is capable of completely predicting the long-term outcomes. The concepts of “Dynamic risk assessment” have important implications on DTC management during follow-up.

Evaluation of the efficacy of RAI therapy rely on anatomical information has been suggested. For those with radioiodine refractory disease, targeted therapy with small molecular inhibitor of tyrosine protein kinases (TKI) may improve progress-free survival.

Recently, policy for treating DTCs has changed in many aspects. We have to continue to capture the new information with time to present the best treatments for DTC patients.