New paradigms in the treatment of low-risk thyroid cancer

ABSTRACT

Introduction

Thyroid cancer is the most common endocrine malignancy. Multiple different staging systems have been introduced and used for differentiated thyroid carcinoma (DTC).

Areas covered

In this literature review we provide an overview of the standard options for management of patients with low risk differentiated thyroid cancer.

Expert opinion

Surgery is considered the first and most important step in managing DTC with goal to remove all the malignant foci in order to achieve cure and increase the survival with least chance of recurrence. Many studies have been conducted to determine the best surgical approaches and how aggressive surgeries should be in order to achieve the best outcomes regarding efficacy as well as safety. Radioactive iodine (RAI) therapy has also been a part of the treatment regimen and is used for different purposes with three main goals: post-surgical ablation, adjuvant therapy and persisted/recurrent disease treatment. Radiation therapy, on the other hand, is still not recommended to be used routinely in DTC because of the conflicting data of its benefit.

KEYWORDS:

• Thyroid cancer
• low risk
• prognosis
• therapy

Article highlights

• Thyroid cancer is the most common endocrine malignancy and differentiated thyroid cancer accounts for the majority of it.

• The incidence of thyroid cancer is rapidly increasing worldwide.

• AJCC/TNM staging system and ATA risk stratification system are essential in evaluating the mortality and recurrence in DTC.

• Surgery is the most important modality in managing thyroid cancer in order to achieve cure.

• Active surveillance is a reasonable approach in low-risk PTMC with less complications compared to surgical approach.

• RAI is not recommended in low-risk DTC cases in the absence of high-risk features.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.