Management of Low-Risk Differentiated Thyroid Cancer |
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Institution: | 1. School of Medicine, Boston University, Department of Medicine and Division of Endocrinology, Diabetes and Weight Management, Boston, Massachusetts;2. Division of Rheumatology, Boston University School of Medicine, Boston, Massachusetts;1. Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España;2. Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España;3. Servicio de Anatomía Patológica, Hospital Clínico Universitario Valladolid, Valladolid, España;1. Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and University Paris-Saclay, Villejuif 94800, France;2. Department of endocrine surgery, Hôpital Lyon Sud, 165, rue du grand Revoyet, 69495 Pierre-Bénite, France;3. Inserm U1290, Research on Healthcare Performance Lab (RESHAPE), Université Claude-Bernard Lyon 1, domaine Rockefeller, 8, avenue Rockefeller, 69003 Lyon, France;1. Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY;2. Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ |
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Abstract: | ObjectiveTo summarize the definitions of and management recommendations for low-risk thyroid cancer made by the American and European Thyroid Associations and synthesize this information with the recent literature, including systematic evaluations of tumor staging systems guiding therapy.MethodsThe American Thyroid Association and European Thyroid Association guidelines were compared and pertinent literature since 2005 was reviewed.ResultsOf papillary thyroid microcarcinomas (PTMC), up to 50% breach the thyroid capsule, 64% have lymph node metastases, up to 43% are multifocal, and as many as 2.8% have distant metastases. Locoregional and distant recurrences are, respectively, as high as 5.9% and 1.5%. As many as 1 in 4 patients with a papillary thyroid carcinoma 1.5 cm or smaller develop persistent disease. Cancer-related mortality rates are usually less than 1%, but are as high as 2% in some reports. Tumor staging systems are too inaccurate to guide therapy.ConclusionIt is unlikely that many patients will forgo treatment after understanding their risk, especially when total thyroidectomy and radioiodine (131I) therapy can reduce the PTMC recurrence or persistence disease rate to zero. Preoperatively diagnosed PTMC should be treated with total or near-total thyroidectomy, regardless of tumor size. For very low-risk patients with unifocal PTMC smaller than 1 cm that is removed by chance during surgery to treat benign thyroid disease, lobectomy alone without 131I therapy may be sufficient therapy if there are no concerning histologic features and no tumor extension beyond the thyroid, metastases, history of head and neck irradiation, or positive family history—any of which requires total or near-total thyroidectomy and remnant ablation with 30 mCi. (Endocr Pract. 2007;13:498-512) |
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