Endocrine Abstracts

The incidence of differentiated thyroid cancer (DTC) has increased worldwide which is mainly attributed to the more common detection of early stage DTC. The prognosis of early stage disease is excellent and the present ATA guidelines suggest less radical treatment and follow-up in these cases. TNM staging, risk classification, indication of radioiodine (RAI) treatment, evaluation of therapeutic response and TSH target range have been recently changed. However, 7–10% of DTC cases develop distant metastases and two-thirds of these patients become RAI-refractory. The management of RAI-refractory patients has markedly developed with the availability of new treatment modalities. The presented cases represent the major challenges during the risk classification, follow-up, treatment of choice and emphasize unresolved questions. The patient with papillary thyroid cancer (PTC) is tumor-free after the primary treatment (surgery and RAI) but rising anti-Tg antibody levels are found in the absence of localizable disease – biochemical incomplete response. Anti-Tg antibody positive PTC patient with rising antibody levels and development of lymph node and RAI-refractory pulmonary metastases 9 years after the diagnosis – percutaneous ethanol sclerotherapy (PEI) of lymph node metastasis. The patient tolerated sorafenib treatment only temporarily due to severe side effects. Young PTC patient diagnosed with advanced disease (pT4N1M1), pulmonary metastases and treated with repeated surgeries including gamma-probe guided operation and five RAI therapies. He is followed for 12 years. When can we stop the RAI therapy? A PTC patient with 30-years disease course who underwent five surgeries, five RAI therapies and PEI of recurrent neck lymph node metastases and suspected tongue metastasis and finally PET/CT detected non-RAI avid lymph node mets in the upper mediastinum. A patient suffering from oncocytic follicular cancer, local relapse, cervical lymph node and pulmonary metastases; 17-years disease duration, 3 surgeries, 3 RAI therapies, 2 irradiations and sorafenib therapy since 2012; successful reintroduction of sorafenib treatment after the surgery of metastatic cervical lymph nodes with rapid progression.