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Dynamic risk assessment in patients with differentiated thyroid cancer

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Abstract

The current approach for patients with differentiated thyroid carcinoma should be individualized according to the risk of recurrence, and this stratification could be used to identify the risk of persistent/recurrent disease in three scenarios: preoperatively, immediately postoperatively, and during long-term follow-up. The initial risk of recurrence will tailor the management of the patient in the preoperative and immediate postoperative settings, while the dynamic risk, which considers the responses to treatment, could guide the decision-making process for remnant ablation and long-term management.

This review provides a summary of the existing information regarding the dynamic risk of recurrence and recommended management for patients with differentiated thyroid cancer. The application of this approach is essential to avoid unnecessary treatments for most patients who will have a favorable prognosis. On the other hand, it allows specific therapeutic interventions for those patients at high risk of recurrence. In the future, analysis of tumor biology and prospective studies will surely improve the accuracy of recurrence risk prediction.

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Abbreviations

FNA:

fine-needle aspiration

CT:

computed tomography

MRI:

magnetic resonance imaging

TL:

Thyroid lobectomy

TT:

total thyroidectomy

OS:

overall survival

DFS:

disease-free survival

DSS:

disease-specific survival

RAI:

radioactive iodine

ATA:

American Thyroid Association

TSH:

thyrotropin

Tg:

thyroglobulin

PTC:

papillary thyroid cancer

TgAb:

anti-thyroglobulin antibodies

HT:

Hashimoto’s thyroiditis

HrQoL:

health-related quality of life

LRN:

laryngeal recurrent nerve

DTC:

differentiated thyroid cancer

RR:

risk of recurrence

AS:

active surveillance

FTC:

follicular thyroid cancer

ETE:

extrathyroidal extension

LN:

lymph node metastasis

BRAF:

Braf oncogene

TERT:

TERT oncogene

US:

ultrasound

RRA:

radioiodine remnant ablation

IR:

indeterminate response

BIR:

biochemical incomplete response

SIR:

structural incomplete response

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  1. Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina

    Erika Abelleira & Fernando Jerkovich

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Abelleira, E., Jerkovich, F. Dynamic risk assessment in patients with differentiated thyroid cancer. Rev Endocr Metab Disord 25, 79–93 (2024). https://doi.org/10.1007/s11154-023-09857-7

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