2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer

Yi, Ka Hee; Lee, Eun Kyung; Kang, Hee Yoon; Koh, Yunwoo; Kim, Sun Wook; Kim, In Joo; Na, Dong Gyu; Nam, Kee Hyun; Park, So Yeon; Park, Jin Woo; Bae, Soochan; Baek, Seung Kuk; Baek, Jung Hwan; Lee, Byung‐Joo; Chung, Ki-Wook; Jung, Yuh Seog; Cheon, Gi Jeong; Kim, Won; Chung, Jae Hoon; Rho, Young Soo

doi:10.11106/ijt.2016.9.2.59

Cited by 92 publications

(65 citation statements)

References 553 publications

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“…Thyroid nodules that were hypoechoic (taller-than-wide) or had microcalcifications, irregular margins, or extrathyroidal extensions (ETEs) were defined as highly suspicious, whereas those with cystic lesions or a spongiform appearance were defined as benign. [ 2 , 3 ] Most respondents reported initiating US-guided FNA for nodules at least 5 mm in size (60%) in the presence of malignant features (Fig. 1 A).…”

Section: Resultsmentioning

confidence: 99%

“…Active surveillance was introduced in the 2015 ATA and 2016 KTA guidelines because of the slow growth of MPTC. [ 2 , 3 ] In this survey, the prerequisite for active MPTC surveillance was an intraparenchymal lesion without lymph node metastasis. The presence of a suspicious ETE increased the preference for surgical resection of the thyroid, either lobectomy or total thyroidectomy, with none of the respondents preferring active surveillance alone in such cases.…”

Section: Discussionmentioning

confidence: 99%

“…Based on available evidence and risk stratification, guidelines from the American Thyroid Association (ATA), British Thyroid Association, National Comprehensive Cancer Network, and Korean Thyroid Association (KTA) have been published to help physicians make practical decisions regarding the optimal treatment of patients diagnosed with thyroid cancer. [ 1 – 3 ] However, not every guideline is applicable to all patients and physicians. In addition, these guidelines do not accurately take into consideration the clinical environment or the status of an individual patient, including the patient's tumor progression history or socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

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Current trends of practical issues concerning micropapillary thyroid carcinoma

Lee

Hong

et al. 2017

Medicine

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Although several thyroid associations have published various guidelines, controversies especially in cases of micropapillary thyroid cancer (MPTC) still exist. This survey was designed to collect information about diagnostic tests and treatments performed on patients with MPTC and help identify current trends in thyroid surgery.We developed questionnaires about the management methods for MPTC, which were used to identify factors related to indications of fine needle aspiration (FNA), type of surgery, and central lymph node dissection (CLND). Active 60 members of the Korean Society of Thyroid-Head and Neck Surgery participated in the study in September 2016.Ultrasound-guided FNA was usually initiated when the tumor was at least 5 mm (60%). All respondents preferred ultrasound-guided FNA and surgery for nodules with extrathyroidal extension (ETE). The preferred treatment option for intraglandular MPTC was lobectomy (92%) rather than active surveillance (8%). Posterolateral ETE increased the respondents’ preference for total thyroidectomy (61.7%). Active surveillance was preferred for tumors <5 mm, which was decreased by the presence of ETE. The presence of ETE (73.3%) and its proximity to critical organs (46.7%) were the main determining factors for prophylactic CLND. For multiple metastatic lymph nodes at level III, selective neck dissection including levels IIb (23.3%) and V (78.3%) was preferred in addition to levels IIa, III, VI, and V.Korean head and neck surgeons favored total thyroidectomy and CLND in cases wherein ETE, central lymph node metastasis, or critical organ involvement was suspected.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current trends of practical issues concerning micropapillary thyroid carcinoma

Lee

Hong

et al. 2017

Medicine

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“…Although most thyroid cancers are well-differentiated carcinomas, which are slow to progress and have an excellent prognosis, up to 30% of patients experience recurrence within 10 years (2,3). To prevent recurrence, the long-term use of levothyroxine (T4) to suppress the endogenous pituitary excretion of thyroidstimulating hormone (TSH), so-called T4 suppression therapy, has been generally considered for thyroid cancer patients at intermediate or high risk for recurrence (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, the suppression of serum TSH concentration by administering levothyroxine was found to improve relapse-free and overall survival in high-risk patients with WDTC (11,12), which supports the proposal that TSH suppression exerts inhibitory effects on the progression of WDTC. Thus, T4 suppression therapy has long been used as an essential therapeutic strategy for the treatment of WDTC, especially in highrisk cases (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Aberrant Thyroid-Stimulating Hormone Receptor Signaling Increases VEGF-A and CXCL8 Secretion of Thyroid Cancer Cells, Contributing to Angiogenesis and Tumor Growth

Song

Kim

Sun

et al. 2019

Clinical Cancer Research

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Purpose: Thyroid-stimulating hormone (TSH) suppression is widely used to treat well-differentiated thyroid cancer, whereas its role in poorly differentiated thyroid cancer (PDTC) is undetermined. Besides thyrocytes, TSH also binds to stromal cells, comprising tumor microenvironments. This study aimed to investigate the effects of TSH on tumor microenvironments in PDTC. Experimental Design: An ectopic tumor model using PDTC cells (BHP10-3SCp and FRO), which exhibit TSH/ cAMP-independent cell growth, was treated with TSH. IHC was performed using tissue microarrays from 13 PDTCs. Results: TSH treatment significantly enhanced tumor growth of PDTCs with increased vascularity but not that of breast cancer cells, suggesting this effect is unique to thyroid cancer cells, not stromal cells. TSH significantly upregulated VEGF-A and CXCL8 expressions in BHP10-3SCp cells via AKT and ERK signaling, resulting in higher concentrations of VEGF-A and CXCL8 in conditioned medium of TSH-treated BHP10-3SCp cells (TSH-CM) compared with controls. TSH-CM treatment enhanced tube formation potentials of endothelial cells, and blocking VEGF and/or CXCL8 reduced them. Blocking VEGF and/or CXCL8 also reduced TSHdependent tumor growth with reduced tumor vasculature in vivo. TSH-treated tumors showed increased macrophage densities, and macrophage inhibition reduced TSH-dependent tumor growth in vivo. In human PDTCs, preoperative TSH levels were positively associated with VEGF-A and tumor size, and the expression of VEGF-A was positively correlated with CD31, CD163, and CXCL8, and their clinical poor prognosis. Conclusions: Aberrant TSH receptor signaling modulates tumor angiogenesis by stimulating VEGF-A and CXCL8 secretion from PDTC cells and enhances tumor growth; thus, TSH suppression is beneficial for treating PDTCs.

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Isthmusectomy in selected patients with well‐differentiated thyroid carcinoma

et al. 2019

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Background: Isthmusectomy in the treatment of well-differentiated thyroid carcinoma (WDTC) is controversial. In this study, we analyze the outcomes of WDTC managed by isthmusectomy alone. Methods: Forty-three patients treated with isthmusectomy alone were identified from an institutional database of 6259 surgically treated patients with WDTC. Patient and tumor characteristics were analyzed. Disease-specific survival (DSS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method. Results: The pT classification was T1 for 41 and T2 for two patients. All were clinical N0, but 10 pts were pN1a. Using the American Thyroid Association risk stratification system, 9 patients were low-risk and 22 were intermediate-risk. One patient developed local recurrence, and two developed regional lymph node metastases; the 5-and 10-year DSS was 100.0%. The 5-and 10-year RFS was 93.1%. Conclusions: Isthmusectomy alone is an acceptable procedure in selected patients with low-and intermediate-risk WDTC limited to the isthmus. K E Y W O R D Sisthmectomy, isthmus, isthmusectomy, low risk cancer, well-differentiated thyroid carcinoma

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2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer

Cited by 92 publications

References 553 publications

Current trends of practical issues concerning micropapillary thyroid carcinoma

Current trends of practical issues concerning micropapillary thyroid carcinoma

Aberrant Thyroid-Stimulating Hormone Receptor Signaling Increases VEGF-A and CXCL8 Secretion of Thyroid Cancer Cells, Contributing to Angiogenesis and Tumor Growth

Isthmusectomy in selected patients with well‐differentiated thyroid carcinoma

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