Current practice in patients with differentiated thyroid cancer

Considerable changes have occurred in the management of differentiated thyroid cancer (DTC) during the past four decades, based on improved knowledge of the biology of DTC and on advances in therapy, including surgery, the use of radioactive iodine (radioiodine), thyroid hormone treatment and availability of recombinant human TSH. Improved diagnostic tools are available, including determining serum levels of thyroglobulin, neck ultrasonography, imaging (CT, MRI, SPECT-CT and PET-CT), and prognostic classifications have been improved. Patients with low-risk DTC, in whom the risk of thyroid cancer death is <1% and most recurrences can be cured, currently represent the majority of patients. By contrast, patients with high-risk DTC represent 5-10% of all patients. Most thyroid cancer-related deaths occur in this group of patients and recurrences are frequent. Patients with high-risk DTC require more aggressive treatment and follow-up than patients with low-risk DTC. Finally, the strategy for treating patients with intermediate-risk DTC is frequently defined on a case-by-case basis. Prospective trials are needed in well-selected patients with DTC to demonstrate the extent to which treatment and follow-up can be limited without increasing the risk of recurrence and thyroid cancer-related death. This Review summarizes clinical practice for differentiated thyroid cancer, highlighting advances in therapy, including surgery and the use of radioactive iodine, as well as improved diagnostic tools and prognostic classifications. Different management strategies for patients with low-risk, intermediate-risk and high-risk differentiated thyroid cancer are discussed.

Automated summary

Considerable changes have occurred in the management of differentiated thyroid cancer (DTC) over the past four decades, with improved diagnostic tools and prognostic classifications available. Low-risk patients make up the majority with good outcomes, while high-risk patients require more aggressive treatment and follow-up due to frequent recurrences.