Thyroid Cancer Guidelines – What's New?

Abstract

UK thyroid cancer survival figures are some of the worst in Europe. The 2002 British Thyroid Association (BTA) guidelines aimed to address this and recommended slightly more aggressive treatment e.g. most patients with a thyroid cancer O1 cm had a thyroidectomy, prophylactic level 6 neck dissection and radioiodine ablation. However side effects have been highlighted e.g. hypoparathyroidism after a level 6 dissection and a dry mouth after radioiodine. The 2007 revised BTA guidelines [1] are less dogmatic wherethereisinsufficientevidencetobeprescriptiveandare more in line with the European Thyroid Association (ETA) and American Thyroid Association (ATA) guidelines published in 2006 [2,3]. Where management is debatable the 2007 BTA guidelines open the possibility of treatment being less aggressive for good prognosis thyroid cancer patients. For these patients the local multidisciplinary teams should discuss anddecideon the treatment based on risk assessment for each individual patient. However, determining the risk of thyroid cancer recurrence and mortality can be difficult. This is reflected in the fact that there are at least 18 different prognostic scoring systems (none are perfect). The similarities and differences in the British, European and American guidelines will be discussed.