Differentiated thyroid cancer: an update

Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Current opinion in oncology (Impact Factor: 3.76). 01/2011; 23(1):7-12. DOI: 10.1097/CCO.0b013e32833fc9d9
Source: PubMed

ABSTRACT The incidence of differentiated thyroid cancer (DTC) is increasing. There remains controversy regarding several aspects of its management, including the need for prophylactic central compartment neck dissection and use of recombinant human thyroid stimulating hormone (rhTSH) for ¹³¹I radioactive iodine remnant ablation in patients with low-risk disease.
Central compartment neck dissection entails removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. Description of the dissection should include the indication (prophylactic vs. therapeutic) and extent of dissection (unilateral vs. bilateral). After 3.7 years, patients who underwent rhTSH-assisted ablation appeared to have similar rates of ablation as patients who underwent thyroid hormone withdrawal using criteria of negative whole body scans (84% of euthyroid and 94% of hypothyroid patients) and stimulated thyroglobulin less than 2 ng/ml (95%, euthyroid; 96%, hypothyroid). In the United States, rhTSH would cost $15,994 per patient, with an incremental societal cost of $1365 per patient and incremental cost-effectiveness ratio of $52,554/quality-adjusted-life-year.
The use of rhTSH in patients with low-risk DTC undergoing thyroid remnant ablation appears to have similar efficacy in remnant ablation and tumoricidal effects and is associated with improved patient quality of life. Cost-effectiveness appears to be above the conventional threshold for cost-effectiveness, but is dependent on cost of rhTSH, patient utility, days off work, and rates of remnant ablation.

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    ABSTRACT: To evaluate the relationship between microscopic cancerous involvement of surgical margin and recurrence in patients with differentiated papillary thyroid cancer (PTC) who underwent total thyroidectomy followed by high-dose radioactive iodine ablation (HDRIA). Consecutive 197 PTC patients (184 women; mean age 44.9 years) who underwent total thyroidectomy without gross residual tumor followed by HDRIA were retrospectively reviewed. Resection margin involvement was evaluated and recurrence of the disease was assessed with clinicopathologically. Recurrence detected within 12 months after HDRIA were defined as early recurrence, detected after 12 months were defined as late recurrence. The mean follow-up was 85.9 ± 16.6 months. Twelve patients (6.1%) had microscopic cancerous involvement of surgical margin [margin (+) group], and 185 patients had negative surgical resection margins [margin (-) group]. Three patients (25.0%) in the margin (+) group and 11 patients (5.9%) in the margin (-) group had early recurrence. Margin (+) group showed higher incidence of early recurrence and lower incidence of disease free compared to margin (-) group (25.0 vs. 5.9%, p < 0.01; 66.7 vs. 81.1%, p < 0.01, respectively); however, there was no difference in incidence of late recurrence between the two groups (p = 1.00). There were no significant differences in the disease-free survival between the margin (+) and margin (-) groups after exclusion of early recurrence (p = 0.78). After high-dose radioactive iodine ablation, PTC patients with microscopic cancerous surgical margin involvement had a higher incidence of early recurrence and no different late recurrence rate compared to patients without microscopic cancerous surgical margin involvement.
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    ABSTRACT: Background and purpose We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of recombinant human thyrotropin (rhTSH) and thyroid hormone withdrawal (THW) on thyrotropin stimulation prior to remnant ablation of differentiated thyroid cancer (DTC). Material and methods A comprehensive search was conducted for articles discussing rhTSH and THW prior to December 2012. After applying the inclusion criteria, all the available data were summarized to analyze the efficacy of rhTSH and THW for stimulating TSH. Results Seven RCTs that involved a total of 1535 patients, were included in the analysis. The ablation rates of the rhTSH group and the THW group were not significantly different (RR = 0.97, 95% CI: 0.94–1.01, p = 0.1). Patients in the rhTSH group had a better quality of life (QoL) than those in the THW group on the day of ablation (RR = 3.92, 95% CI: 3.44–5.40, p < 0.00001). However, there was no difference in the QoL 3 months after ablation (RR = −0.9, 95% CI: −2.20–0.39, p = 0.17). Additionally, there were no significant differences in serum thyroglobulin (Tg) levels measured just before radioiodine remnant ablation (preablation thyroglobulin levels) (RR = −0.14, 95% CI: −0.73–0.45, p = 0.65), or in days of hospital isolation (RR = −10.51, 95% CI: −32.79–11.73, p = 0.35) Conclusions Our findings indicate that the administration of rhTSH had resulted in an ablation rate similar to that of THW for DTC patients, but rhTSH provided a better QoL at the time of ablation.
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