The treatment of well-differentiated thyroid cancer

Abstract

The management of well differentiated thyroid cancer continues to generate considerable debate and controversy regarding diagnostic evaluation, extent of surgery, and postoperative adjuvant therapy and follow-up. The fine-needle aspiration biopsy has been routinely used for diagnostic evaluation of thyroid nodule. Understanding prognostic factors and risk group analysis is extremely crucial in the overall management of thyroid cancer regarding the extent of thyroidectomy and adjuvant therapy. Patients in the low-risk group do extremely well and can be treated with lobectomy alone while those in the high-risk group invariably require total thyroidectomy due to the need of adjuvant radioactive iodine treatment. Thyroglobulin appears to be a good tumor marker in patients who have undergone total thyroidectomy during follow-up. One of the major nuances in the management of thyroid cancer is the availability of recombinant TSH which can be used for radioactive iodine dosimetry during the follow-up of patients with well differentiated thyroid cancer. This prevents patients from becoming hypothyroid for an extended period of time which directly affects their quality of life. Understanding poorly differentiated thyroid cancer is extremely crucial as an important histologic prognostic factor and generally being nonradioavid tumors. PET scan is useful in the follow-up of these patients to evaluate the extent of distant metastasis.