Management Of Differentiated Thyroid Carcinoma Research Articles

Differentiated thyroid carcinoma: what the nonspecialists needs to know.

Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents.

New national recommendations for the treatment of pediatric differentiated thyroid carcinoma in the Netherlands.

Currently, there are no European recommendations for the management of pediatric thyroid cancer. Other current international guidelines are not completely concordant. In addition, medical regulations differ between, for instance, the US and Europe. We aimed to develop new, easily accessible national recommendations for differentiated thyroid carcinoma (DTC) patients <18 years of age in the Netherlands as a first step toward a harmonized European Recommendation. A multidisciplinary working group was formed including pediatric and adult endocrinologists, a pediatric radiologist, a pathologist, endocrine surgeons, pediatric surgeons, pediatric oncologists, nuclear medicine physicians, a clinical geneticist and a patient representative. A systematic literature search was conducted for all existing guidelines and review articles for pediatric DTC from 2000 until February 2019. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used for assessing quality of the articles. All were compared to determine dis- and concordances. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework to develop specific Dutch recommendations. Discussion points based upon expert opinion and current treatment management of DTC in children in the Netherlands were identified and elaborated. Based on the most recent evidence combined with expert opinion, a 2020 Dutch recommendation for pediatric DTC was written and published as an online interactive decision tree (www.oncoguide.nl). Pediatric DTC requires a multidisciplinary approach. The 2020 Dutch Pediatric DTC Recommendation can be used as a starting point for the development of a collaborative European recommendation for treatment of pediatric DTC.

Chance and challenge in the management of differentiated thyroid carcinoma with 131I

Chance and challenge in the management of differentiated thyroid carcinoma with 131I

Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative131I whole-body scan results: A meta-analysis

The purpose of this review was to present a meta-analysis aimed to evaluate the accuracy of positron emission tomography (PET) and PET-CT for detecting recurrence of differentiated thyroid carcinoma (DTC) not identified by (131) I whole-body scintigraphy. MEDLINE, EMBASE, LILACS, and Cochrane databases were searched for studies published between January 1985 and March 2012. Systematic methods were used to select and evaluate the quality of studies. Pooled sensitivity and specificity for conventional PET and PET-CT was estimated using random effects model. Twenty studies were included in the systematic review; the data of 18 studies were used in the meta-analysis. The combined sensitivity and specificity for conventional PET were both found to be 84%; for PET-CT, they were 93% and 81%, respectively. The overall accuracies were 91% and 93%, respectively. (18) Fluorodeoxyglucose (FDG)-PET and PET-CT are highly accurate diagnostics tools for DTC recurrence in patients who present a negative whole-body scintigraphy and could impact the clinical and therapeutic management of DTC.

Diagnostic and therapeutic use of recombinant human TSH (rhTSH) in differentiated thyroid cancer

Traditionally, withdrawal of thyroid hormone to increase serum levels of thyroid-stimulating hormone (TSH) has been used in patients with differentiated thyroid carcinoma (DTC) to optimize radio-iodine uptake and serum thyroglobulin (Tg) stimulation during follow-up and in preparation for radio-iodine therapy. However, this procedure is associated with signs and symptoms of hypothyroidism which negatively affect the patient's quality of life. Recombinant human thyrotropin (rhTSH) has provided an effective alternative to thyroid hormone withdrawal. After favourable experimental trials in humans, rhTSH obtained regulatory approval in North America and in Europe as a diagnostic tool, and more recently as a preparation for radio-iodine thyroid remnant ablation. Since then, rhTSH has radically changed the diagnostic and therapeutic management of DTC patients. This review will focus on the clinical application of rhTSH in the management of DTC, highlighting current indications and future perspectives.

Incremental Value of 131I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

(131)I whole-body scintigraphy (WBS) is a highly sensitive method for the detection of differentiated thyroid tumors and metastases. However, a lack of anatomic landmarks and the physiologic accumulation of the tracer complicate interpretation of the images. This prospective study was designed to evaluate the incremental value of (131)I SPECT/CT over planar WBS in the management of patients with differentiated thyroid carcinoma (DTC). Planar imaging was performed on 66 consecutive DTC patients who were considered to have locally advanced or metastatic disease after total or nearly total thyroidectomy. SPECT/CT was added for patients whose planar findings were inconclusive. The planar images were interpreted by 2 experienced nuclear medicine physicians. Interpretation of the SPECT/CT images was a consensus opinion of one of the nuclear medicine physicians and an experienced radiologist. Fusion images were considered to improve image interpretation when they better localized sites of increased (131)I uptake. The final diagnosis was verified by pathologic findings, other imaging modalities, and clinical follow-up. Both site-based and patient-based analyses were performed, and the impact of SPECT/CT results on therapeutic strategy was assessed. A total of 232 foci were observed by (131)I WBS, including 33.2% of foci localized in the thyroid bed, 62.1% due to malignant lesions, and 4.7% caused by nonthyroidal physiologic or benign uptake or a contaminant. Overall, 37 SPECT/CT studies were performed on 23 patients, whose planar images showed 81 inconclusive lesions. Precise localization and characterization of (131)I-avid foci were achieved through (131)I SPECT/CT in 69 (85.2%) and 67 (82.7%) of the 81 foci, respectively. Fusion images were considered to be of benefit in 17 (73.9%) of 23 patients. The therapeutic strategy was changed in 8 (47.1%) of 17 patients. Uncommon metastatic lesions were found in 9 (13.6%) of 66 patients with regard to SPECT/CT fusion images. Fusion of SPECT and CT images was of incremental value over WBS in increasing diagnostic accuracy, reducing pitfalls, and modifying therapeutic strategies in 73.9% of DTC patients. As SPECT/CT techniques emerge, (131)I SPECT/CT may demonstrate higher value than WBS in the management of DTC.

Late Disease Recurrence in Patients Diagnosed With and Treated for Differentiated Thyroid Carcinoma

Purpose: Differentiated thyroid carcinoma (DTC) is an uncommon cancer that typically has an excellent long-term prognosis. However, a frequent pitfall in the management of DTC is an underappreciation of the potential for recurrence after a lengthy disease-free interval. We report 6 cases of DTC that recurred more than 10 years after the initial diagnosis and treatment. Methods: During a recent review of the management of DTC at The University of Texas M. D. Anderson Cancer Center, we identified 4 male and 2 female patients whose disease recurred more than 10 years after the initial diagnosis. The patients were evaluated for demographic information, nature of recurrence, and status at last follow up. Results: Three patients had papillary thyroid carcinoma, one had follicular thyroid carcinoma, and 2 had mixed papillary/follicular thyroid carcinoma. Factors known to influence risk of recurrence (age at diagnosis, initial tumor size, local invasion, metastatic disease at presentation, extent of initial surgery, and radioiodine treatment) were assessed in our patients. In each case, failure to continue close follow up led to delays in diagnosis of disease recurrence. Conclusion: In DTC, clinically significant recurrence may develop after a disease-free interval of many years. Therefore, lifelong surveillance is needed for these patients to ensure timely identification and early treatment.

Carcinoma diferenciado de tireóide: avaliação inicial e acompanhamento

Thyroid carcinoma accounts for roughly 1% of all new malignant diseases. Of these, at least 94% are differentiated thyroid carcinoma (DTC), either papillary thyroid carcinoma or follicular thyroid carcinoma. Patients with DTC are usually considered as having a good prognosis, 80% of patients are cured, 20% will develop loco-regional recurrence and 5-10% distant metastasis. However, the disease may have an aggressive course in some patients. The identification of these patients has a major impact in the clinical management of DTC. Several prognostic factors and classification will be addressed, as well the most useful tests for patients follow-up.

Differentiated thyroid cancer.

The retrospective analysis of the case files of children with differentiated thyroid carcinoma (DTC) was performed to define the disease by its presentation, clinical course and outcome of radioiodine therapy. Between 1967 to October 2002, 1754 patients with thyroid cancer were treated in the Dept of Neuclear Medicine, AIIMS, out of which 122 (7%) were < or = 20 years of age (71 girls and 51 boys). The mean age was 15.8 +/- 3.6 years and the mean duration of follow-up was 90 +/- 59.3 months. Mean tumor size was 4.4 cm. Histologically, 85% of the patients had papillary and rest follicular carcinoma. Cervical lymph node involvement was seen in 64%, and distant metastases, mainly pulmonary, in 23% of the patients. The presentation of the disease was very aggressive in the first decade of life with male preponderance. All but one patient in this age group had nodal and/or distant metastases; in 83.3% the disease had spread to the lymph nodes and 67% had metastases to the lungs. The post-surgery 48-hour mean radioiodine neck uptake was 10.5 +/- 7.6%. 94% of the residual thyroid, 88% of nodal metastases and 71% of pulmonary metastases were ablated requiring mean cumulative doses of 2.8 +/- 2.7 GBq, 4.5 +/- 2.7 GBq and 10.4 +/- 7.9 GBq of 131I, respectively. Average number of doses required for remnant, nodal and pulmonary metastases ablation were 1.3, 2.2 and 3.3, respectively. 80% of the patients with only remnant thyroid tissue and 50% with cervical lymph node metastases got ablated with a single dose of 131I. Overall, 87% patients were currently free of disease. While, nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter and 3 disease related deaths producing overall mortality of 2.5% (all in children < or =10 years of age) were seen in the mean follow-up of 7.5 years. Differentiated thyroid cancer in children and adolescents is rare but aggressive. The biological behavior differs from that in adults and is related to the age. Younger the age (< or =10 years), more aggressive and widespread is the disease with male preponderance and high mortality. The post-surgical radioiodine ablation/therapy is an important and effective adjuvant in the management of DTC in children and adolescents and even though they present with advance disease, long-term survival and overall prognosis is good.