Skip to main content

Advertisement

SpringerLink
Log in

Well Differentiated Thyroid Carcinoma: Current Treatment

  • Head and Neck Cancer (T Day, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Well differentiated thyroid carcinoma (WDTC) is a relatively common malignancy accounting for an estimated 37,000 thousand cases in the United States in 2009 [1]. WDTC also has a generally high 5 year survival rate that correlates with age. Papillary thyroid carcinoma (PTC) greater than 1 cm is best managed by total thyroidectomy. Thyroid lobectomy and isthmusectomy may be adequate for unifocal PTC less than 1 cm in patients without negative prognostic factors. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular Interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, et al. Cancer Statistics 2009. CA Cancer J Clin. 2009;59:225–49.

    Article  PubMed  Google Scholar 

  2. Cramer JD, et al. Analysis of the rising incidence of thyroid cancer using the Surveillance, Epidemiology and End Results national cancer data registr. Surgery. 2010;148(6):1147–52. discussion 1152–3.

    Article  PubMed  Google Scholar 

  3. Kebebew E, Weng J, Bauer J, Ranvier G, Clark OH, Duh Q-Y, Shibru G, Bastian B, Griffin A. The Prevalence and Prognostic Value of BRAF Mutation in Thyroid Cancer. Ann Surg. 2007 September; 246(3): 466–471.

    Article  PubMed  Google Scholar 

  4. Boudourakis LD, et al. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250(1):159–65.

    Article  PubMed  Google Scholar 

  5. Hundahl SA, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000;89(1):202–17.

    Article  PubMed  CAS  Google Scholar 

  6. Flynn MB, et al. Local complications after surgical resection for thyroid carcinoma. Am J Surg. 1994;168(5):404–7.

    Article  PubMed  CAS  Google Scholar 

  7. Morton, R.P., P. Whitfield, and S. Al-Ali, Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 2006. 31(5): p. 368–74.

  8. Pagedar NA, Freeman JL. Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Arch Otolaryngol Head Neck Surg. 2009;135(4):360–2.

    Article  PubMed  Google Scholar 

  9. Sabour S, Manders E, Steward DL. The role of rapid PACU parathyroid hormone in reducing post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg: Off J Am Acad of Otolaryngol Head Neck Surg. 2009;141(6):727–9.

    Article  Google Scholar 

  10. Bilimoria KY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375–81. discussion 381-4.

    Article  PubMed  Google Scholar 

  11. Jonklaas J, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid: Off J Am Thyroid Assoc. 2006;16(12):1229–42.

    Article  Google Scholar 

  12. Baudin E, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998;83(3):553–9.

    Article  PubMed  CAS  Google Scholar 

  13. Thyroid Carcinoma. NCCN Clinical Practice Guidelines in Oncology 2011 [cited 2011; 3.2011]Available from: www.nccn.org.

  14. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.

    Article  PubMed  CAS  Google Scholar 

  15. Carty SE, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid: Off J Am Thyroid Assoc. 2009;19(11):1153–8.

    Article  Google Scholar 

  16. Shaha, A.R., Controversies about the central compartment in thyroid cancer. Editorial regarding the article “Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases” by Alexandre Bozec et al. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies, 2011. 268(8): p. 1097–9.

  17. Zetoune T, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17(12):3287–93.

    Article  PubMed  Google Scholar 

  18. Ecker T, et al. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques--a meta-analysis. Otolaryngol Head Neck Surg: Off J Am Acad Otolaryngol Head Neck Surg. 2010;143(1):17–25.

    Article  Google Scholar 

  19. Higgins TS, et al. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope. 2011;121(5):1009–17.

    Article  PubMed  Google Scholar 

  20. Samraj, K. and K.S. Gurusamy, Wound drains following thyroid surgery. Cochrane database of systematic reviews, 2007(4): p. CD006099.

  21. Miccoli P, et al. Minimally invasive surgery for thyroid small nodules: Preliminary report. J Endocrinol Invest. 1999;22:849–51.

    PubMed  CAS  Google Scholar 

  22. Miccoli P, et al. Video-assisted thyroidectomy: indications and results. Langenbecks Arch Surg. 2006;391:68–71.

    Article  PubMed  Google Scholar 

  23. Sgourakis G, et al. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: is there any evidence-based information? Thyroid: Off J Am Thyroid Assoc. 2008;18(7):721–7.

    Article  Google Scholar 

  24. Byrd JK, et al. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: a cost-effective analysis. Otolaryngol Head Neck Surg: Off J Am Acad Otolaryngol Head Neck Surg. 2010;143(6):789–94.

    Article  Google Scholar 

  25. Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope. 2011;121(3):521–6.

    Article  PubMed  Google Scholar 

  26. Tae, K., et al., Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head & Neck, 2011.

  27. Terris DJ, Singer MC, Seybt MW. Robotic facelift thyroidectomy: patient selection and technical considerations. Surg Laparosc Endosc Percutan Tech. 2011;21(4):237–42.

    Article  PubMed  Google Scholar 

  28. Wilhelm T, Metzig A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J Surg. 2011;35(3):543–51.

    Article  PubMed  Google Scholar 

  29. DeGroot LJ, et al. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990;71(2):414–24.

    Article  PubMed  CAS  Google Scholar 

  30. Sawka AM, et al. Clinical review 170: A systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004;89(8):3668–76.

    Article  PubMed  CAS  Google Scholar 

  31. Cooper, D. S., Doherty, G. M., Haugen, B. R., Kloos, R. T., Lee, S. L., Mandel, S. J., Mazzaferri, E. L., McIver, B., Pacini, F., Schlumberger, M., Sherman, S. I., Steward, D. L. & Tuttle, R. M. (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–1214. doi:10.1089/thy.2009.0110.

    Article  PubMed  Google Scholar 

  32. Jukkola A, et al. Prognostic Factors in Differentiated Thyroid Carcinomas and Their Implications for Current Staging Classifications. Endocr Relat Cancer. 2004;11:571–9.

    Article  PubMed  Google Scholar 

  33. Meier D, et al. Procedure guideline for Therapy of Thyroid Disease with 131Iodine. J Nucl Med. 2002;43(6):856–61.

    PubMed  CAS  Google Scholar 

  34. Robbins RJ, et al. A retrospective review of the effectiveness of recombinant human TSH as a preparation for radioiodine thyroid remnant ablation. J Nucl Med: Off Publ, Soc Nucl Med. 2002;43(11):1482–8.

    CAS  Google Scholar 

  35. Tala H, et al. Five-Year Survival is Similar in Thyroid Cancer Patients with Distant Metastases Prepared for Radioactive Iodine Therapy with either Thyroid Hormone Withdrawal or Recombinant Human TSH. J Clin Endocrinol. 2011;96(7):2105–11.

    Article  CAS  Google Scholar 

  36. Sisson JC, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine (1)(3)(1)i: practice recommendations of the american thyroid association. Thyroid: Off J Am Thyroid Assoc. 2011;21(4):335–46.

    Article  Google Scholar 

  37. Lee SL. Complications of radioactive iodine treatment of thyroid carcinoma. J Natl Compr Cancer Netw: JNCCN. 2010;8(11):1277–86. quiz 1287.

    Google Scholar 

  38. Perez CA, Santos ES, Arango BA, Raez LE, Cohen EW. Novel molecular targeted therapies for refractory thyroid cancer. Head Neck Epub ahead of print doi: 10.1002/hed.21755 2011.

  39. Monchik, et al. Radiofrequency Ablation and Percutaneous Ethanol Injection Treatment for Recurrent Local and Distant Well-Differentiated Thyroid Carcinoma. Ann Surg. 2006;244(2):296–304.

    Article  PubMed  Google Scholar 

  40. Biondi B, Filetti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab. 2005;1:32–40. doi:ncpendmet0020[pii]10.1038/ncpendmet0020.

    Article  PubMed  CAS  Google Scholar 

  41. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D’Agostino RB. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–52. doi:10.1056/NEJM199411103311901.

    Article  PubMed  CAS  Google Scholar 

  42. Fazio S, Biondi B, Carella C, Sabatini D, Cittadini A, Panza N, Lombardi G, Sacca L. Diastolic dysfunction in patients on thyroid-stimulating hormone suppressive therapy with levothyroxine: beneficial effect of beta-blockade. J Clin Endocrinol Metab. 1995;80:2222–6.

    Article  PubMed  CAS  Google Scholar 

  43. Bauer DC, Ettinger B, Nevitt MC, Stone KL. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Intern Med. 2001;134:561–8.

    PubMed  CAS  Google Scholar 

  44. Kloos RT. Papillary thyroid cancer: medical management and follow-up. Curr Treat Options Oncol. 2005;6:323–38.

    Article  PubMed  Google Scholar 

  45. Tuttle, R. M., Leboeuf, R. & Shaha, A. R. (2008) Medical management of thyroid cancer: a risk adapted approach. J Surg Oncol 97, 712-716. doi:10.1002/jso.21010.

    Article  PubMed  Google Scholar 

  46. Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, Haugen BR, Sherman SI, Cooper DS, Braunstein GD, Lee S, Davies TF, Arafah BM, Ladenson PW, Pinchera A. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:1433–41.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Conflicts of Interest: JK Byrd: none, RJ Yawn: none, CST Wilhoit: none, ND Sora: none, L Meyers: none, J Fernandes: none, T Day: honoraria from Bristol-Myers and Eli Lilly

Author information

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA

    J. Kenneth Byrd MD, Robert J. Yawn BS, Christina S. T. Wilhoit BA, CCRP & Terry Day MD

  2. Division of Endocrinology, Diabetes & Medical Genetics, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 816, Charleston, SC, 29425, USA

    Nicoleta D. Sora MD, Linda Meyers MD & Jyotika Fernandes MD

Authors
  1. J. Kenneth Byrd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert J. Yawn BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christina S. T. Wilhoit BA, CCRP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicoleta D. Sora MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linda Meyers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jyotika Fernandes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Terry Day MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Kenneth Byrd MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Byrd, J.K., Yawn, R.J., Wilhoit, C.S.T. et al. Well Differentiated Thyroid Carcinoma: Current Treatment. Curr. Treat. Options in Oncol. 13, 47–57 (2012). https://doi.org/10.1007/s11864-011-0173-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-011-0173-1

Keywords

Search

Navigation