An update on the management of low-risk differentiated thyroid cancer

Abstract

Low-risk papillary cancers, which represent the vast majority of thyroid cancers diagnosed today, do not require aggressive treatment or follow-up. Initial treatment consists of a total thyroidectomy without prophylactic lymph node dissection. A hemithyroidectomy is an alternative in some patients with an intrathyroidal tumor and with a normal contralateral lobe at pre-operative neck ultrasonography. The use of post-operative radioiodine should be restricted to selected patients. Follow-up at 6-18 months is based on serum thyroglobulin (Tg), Tg-antibody determination and neck ultrasonography. In the absence of any abnormality (excellent response to treatment), the risk of recurrence is extremely low and follow-up may consist of serum TSH monitoring that is maintained in the normal range, and a Tg and Tg-antibody titer determination every year. There is no need for referral to a specialized center. In patients with detectable serum Tg or detectable Tg antibodies, the trend over time of these markers on levothyroxine treatment will dictate subsequent follow-up: a decreasing trend is reassuring, but an increasing trend should lead to imaging, starting with neck ultrasonography.

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

“…About twothirds of neck lymph nodes classified as indeterminate will spontaneously disappear (38). Simple surveillance is a safe approach for the management of these indeterminate lesions (38,65,66).…”

Unstimulated Serum Thyroglobulin Levels after Thyroidectomy and Radioiodine Therapy for Intermediate-Risk Thyroid Cancer Are Not Always a Reliable Marker of Lymph Node Recurrence: Case Report and a Lesson for Clinicians

“…Serum Tg levels reflect the tumour burden or the capacity of the tumour to synthesize and secrete Tg and are used to detect recurrence of thyroid cancer after primary treatment (surgery and RAI when performed). The greatest accuracy on the basal ultrasensitive Tg assay is achieved by setting a cut-off of 0.2–0.3 ng/ml [ 2 ].…”

“…The treatment paradigm for DTC consists of total thyroidectomy, followed by remnant ablation with RAI, and L-thyroxine therapy; the amount of TSH-suppression must be tailored according to the patient's category of risk [ 2 ]. Cornerstones of follow-up are neck US and the measurement of serum Tg levels, anti-Tg antibodies, and TSH levels.…”

“…18F-FDG PET/CT is a reliable tool for the restaging of DTC patients who have undergone surgery and display increased (generally >10 ng/ml) Tg levels and negative neck US or whole-body scan (WBS) [ 3 , 4 ]. Surgery is the reference treatment for locoregional disease [ 2 ].…”

Effectiveness of hemi-thyroidectomy in relieving compressive symptoms in cases with large multi nodular goiter

“…Ten to 15% of patients with goiter ultimately require operative intervention, with surgery being an important treatment option that can immediately resolve local symptoms [ [7] , [8] , [9] ]. Moreover, operative options for benign thyroid conditions include hemi- and total thyroidectomy (TT), and the most ideal option to resolve compressive symptoms remains a matter of debate [ [9] , [10] , [11] , [12] ]. The surgical management of multinodular goiter (MNG) has evolved since the early 1990s, whereby subtotal thyroidectomy was gradually replaced by TT which later on TT took over almost half of the entire thyroid operation.…”