Endocrine Abstracts

The American Thyroid Association has recently developed updated guidelines for the management of thyroid nodules and thyroid cancer. Compared to previous editions, this new guidelines give important new recommendation on several issues.

Initial treatment for thyroid cancer is total thyroidectomy. After total thyroidectomy, patients are treated with ¹³¹I activities aimed at ablating any remnant thyroid tissue. Radioiodine ablation is recommended in high-risk patients and in some low risk patients, while there is no indication in very low risk patients. The method of choice for preparation to perform a radioiodine ablation is based on the administration of recombinant human TSH.

After thyroid ablation, aim of follow-up is the early discovery and treatment of persistent or recurrent disease. At 6 to 12 months the follow-up is based on physical examination, neck ultrasound, rhTSH stimulated serum Tg measurement. At this time nearly 80% of the patients will belong to the low risk categories and will disclose normal neck ultrasound and undetectable (<1.0 ng/ml) stimulated serum Tg in the absence of serum Tg antibodies. These patients may be considered in complete remission.

The few patients with persistent disease, require imaging techniques for the localization of disease. Included in this category are the 5–10% of DTC patients that presented with local or distant metastases at diagnosis and an additional 5–10% that develop recurrent disease during follow-up. When appropriately treated, 2/3 of those patients with local disease and 1/3 of those with distant disease may achieve complete remission. Lung macro-nodules may benefit from radioiodine therapy but the definitive cure rate is very low. Bone metastases have the worst prognosis. Whenever radioiodine therapy is not effective and the disease progress, patients are candidate to treatment with tyrosine kinase inhibitors which have been recently approved after successful outcome of several clinical trials.