INNOVATION IN THE POST-SURGICAL MENAGMENT OF DIFFERENTIATED THYROID CARCINOMA

Differentiated thyroid carcinoma (DTC), either papillary or follicular, has usually a very good prognosis with an overall mortality of less than 10%. In recent decades, the clinical presentation of DTC has been changing from advanced cases requiring intense treatment and surveillance to cancer detected by fortuitous neck ultrasonography requiring less aggressive treatment and follow-up. The initial treatment for DTC is total or near-total thyroidectomy whenever the diagnosis is made before surgery. Central compartment and possible lateral neck dissections should be performed when nodal metastases are present in the respective nodal basins. Post-operatively, radioactive iodine ablation with 131I followed by thyroid stimulating hormone (TSH) suppression is indicated in certain patients to improve locoregional control and reduce recurrence. After initial treatment thyroidectomy and radioiodine ablation), the objectives of the follow-up of DTC is to maintain adequate thyroxine therapy and to detect persistent or recurrent disease through the combined use of neck ultrasound and basal and stimulated serum thyroglobulin (Tg) with or without diagnostic whole body scan (WBS). Recent advances in the radioidine therapy and follow-up of DTC are related to the use of recombinant human TSH (rhTSH) in order to stimulate Tg production and radioiodine uptake, and the ultrasensitive methods for Tg measurement during follow-up.