Management guidelines for patients with thyroid cancer

Kim, Won Bae

Abstract

Incidence of well differentiated thyroid carcinomas (WDTC) has rapidly increased in many countries including Korea recently. Risk stratification of patients with WDTC guides treatment and follow-up strategy of patients, and can classify patients into 'very low risk', 'low risk', 'intermediate risk', and 'high risk' of cancer-specific mortality according to characteristics of tumor and of patients. Proper risk stratification requires adequate lymph node dissection and standardized description of pathologic specimen after first surgery for WDTC. Standard treatment modality of WDTC is total or near-total thyroidectomy followed by radioiodine remnant ablation and thyroxine suppression to decrease serum TSH to target levels. 'Very low risk' patients can be treated by lobectomy without remnant ablation, and most other patients with WDTC are candidates for 'standard treatment'. However, there are controversies in optimal treatment modality for patients with 'low risk' and 'intermediate risk' patients. Especially, the optimal treatment for patients with micro-PTC (small papillary thyroid cancers) is not known, and it requires more accumulation of data on their clinical course. Management of patients with WDTC who fails to get remission after standard therapy is problematic. Many new chemotherapeutic agents and targeted therapy are under development and some are under evaluation by clinical studies for those patients.