Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987–2012

Carhill, Aubrey A.; Litofsky, Danielle R.; Ross, Douglas S.; Jonklaas, Jacqueline; Cooper, David S.; Brierley, James D.; Ladenson, Paul W.; Ain, Kenneth B.; Fein, Henry G.; Haugen, Bryan R.; Magner, James A.; Skarulis, Monica C.; Steward, David L.; Xing, Mingxhao; Maxon, Harry R.; Sherman, Steven I.

doi:10.1210/jc.2015-1346

Cited by 146 publications

(104 citation statements)

References 41 publications

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“…This approach signiicantly decreases mortality and recurrence in DTC [63]. The exact amount of needed suppression is not clear but studies show that reducing TSH level to less than 0.1mU/L improves clinical outcome; however moderate reductions are beneicial [64, 65]. This treatment may have some complications like osteoporosis in postmenopausal women or angina and atrial ibrillation in elderly patients; so the risk of complications should be weighed against the risk of proliferation of malignant cells [66].…”

Section: Diagnosis and Management Of Head And Neck Cancer 64mentioning

confidence: 99%

Thyroid Cancers: Considerations, Classifications, and Managements

Khosravi¹,

Kouhi²,

Saeedi³

et al. 2017

Diagnosis and Management of Head and Neck Cancer

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Rapidly increasing trend of thyroid cancer incidence has turned this disease into a global concern. An estimated number of 64,300 new cases of thyroid cancer occurred in men and women in 2016, which represents 3.8% of all new cancer cases of USA (htps://seer. cancer.gov/statfacts/html/thyro.html). Thus, there is a high possibility for every physician to encounter a case of thyroid cancer during his/her professional lifetime. In this chapter, we clariied epidemiology, diferent categories, and new approaches toward diagnosis and management of thyroid cancer.Keywords: thyroid cancer, epidemiology, diferentiated thyroid cancer, undiferentiated thyroid cancer, thyroid nodule Detailed epidemiology of thyroid cancerAs the most common endocrine cancer and ifth most common cancer in women, thyroid cancer includes approximately 1-1.5% of all new cases of cancer diagnosed annually in the USA based on previous data [1][2][3]. Thyroid cancer is more prevalent among women and those with positive family history of thyroid disease. Some prior studies have reported a worldwide increasing trend for thyroid cancer incidence in recent decades [4]. Annual percent change (APC) is a commonly used indicator for the assessment of changes in incidence. Based on US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, it has been reported 2.4% from 1980 to 1997 and 6.6% from 1997 to 2009 in both genders for thyroid cancer (data available at htp://seer.cancer.gov/statfacts/html/thyro.html).© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.According to [2009][2010][2011][2012][2013] data, the rate of new cases of thyroid cancer was 13.9 per 100,000 men and women per year (Figure 1). Table 1 summarizes number of new cases per 100,000 persons by race/ethnicity and sex. A recently published study on adolescent cancer incidence during 1975-2012 has reported a 2.12% increase for females and 1.59% for males between 15 and 19 years of age [5]. However, there is a study indicating that thyroid cancer incidence trend has slowed following release of American Thyroid Association (ATA) guideline in 2009 [6, 7]. It has been reported that overall thyroid cancer incidence had an increasing trend about 8% per year from 2000 to 2009. But APC showed a deceleration about 3% in men and 2.8% in women, which was conined to tumors less than 2.9 cm of size for women [7].Also, thyroid cancer-related mortality was estimated to consist 0.3% of all cancer-related deaths in 2016. A 5-year survival rate of 98.1% has been reported for thyroid cancer. Despite increasing trend of incidence, thyroid cancer mortality has a relatively stable rate about 0.5 cases per 100,000 persons both from 1973 to 2002 and 2009 to 2013 [8, 9].In conclusion, it seems that thyroid cancer has been following an ...

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Section: Diagnosis and Management Of Head And Neck Cancer 64mentioning

confidence: 99%

Thyroid Cancers: Considerations, Classifications, and Managements

Khosravi¹,

Kouhi²,

Saeedi³

et al. 2017

Diagnosis and Management of Head and Neck Cancer

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“…However, globally, there is no consensus about when patients with RAI refractory DTC should start MKIs when they are asymptomatic and progressing, and such information, supported by broader evidence-based and long-term outcome data, is needed to guide treatment decisions (Carhill et al 2015). …”

Section: Introductionmentioning

confidence: 99%

Timing of multikinase inhibitor initiation in differentiated thyroid cancer

Brose

Smit

Lin

et al. 2017

Endocrine-Related Cancer

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There are limited treatment options for patients with radioactive iodine refractory, progressive differentiated thyroid cancer. Although there is consensus that multikinase inhibitor therapy should be considered in patients with progressive disease with considerable tumor load or symptomatic disease, uncertainty exists on the optimal timing to treat with a multikinase inhibitor, especially for asymptomatic patients. RIFTOS MKI is an international, prospective, open-label, multicenter, noninterventional study with the primary objective to compare the time to symptomatic progression from study entry in asymptomatic patients with radioactive iodine refractory, progressive differentiated thyroid cancer for whom there is a decision to initiate multikinase inhibitors at study entry (cohort 1) with those for whom there is a decision to not initiate multikinase inhibitors at study entry (cohort 2). Secondary endpoints are overall survival and progression-free survival, which will be compared between cohorts 1 and 2. Additional secondary endpoints are postprogression survival from time of symptomatic progression, duration of and response to each systemic treatment regimen and dosing of sorafenib throughout the treatment period. Asymptomatic, multikinase inhibitor-naive patients aged ≥18 years with histologically/cytologically documented differentiated thyroid cancer that is radioactive iodine refractory are eligible. Patients may receive any therapy for differentiated thyroid cancer, including sorafenib or other multikinase inhibitors if indicated and decided on by the treating physician. In total, 700 patients are estimated to be enrolled from >20 countries. Final analysis will be performed once the last enrolled patient has been followed up with for 24 months (ClinicalTrials.gov identifier: Nbib2303444).

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“…This prospective study showed that maintaining serum TSH values in the normal–subnormal range improved the overall survival of patients with stage I–IV disease (see figures 1a–1d), increased the overall survival of patients with distant metastases (figure 1e), and also increased the disease free survival of patients with stage I–III disease (8). Aggressive TSH suppression to achieve a subnormal-undetectable TSH was not necessary to achieve these benefits.…”

Section: The Basics Of Treating Hypothyroidismmentioning

confidence: 85%

“…In contrast with earlier reports from the NTCTCSG (9, 10), aggressive TSH suppression may not be warranted, even in patients diagnosed with distant metastatic disease during follow-up. These latter patients had decreased survival if their TSH values were maintained in the normal-elevated range, compared with the survival of those with undetectable-subnormal and subnormal-normal TSH values (8) However, there was no additional benefit of undetectable-subnormal TSH values compared with subnormal-normal values.…”

Section: The Basics Of Treating Hypothyroidismmentioning

confidence: 99%

Update on the treatment of hypothyroidism

Jonklaas¹

2016

Current Opinion in Oncology

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Purpose of Review Differentiated thyroid cancer is a malignancy that is rapidly increasing in frequency. As thyroidectomy plays a central role in the treatment of thyroid cancer, it is incumbent on physicians treating this patient group to be well versed in the intricacies of treating hypothyroidism. Recent findings Treatment of hypothyroidism may be refined by careful attention to dose selection, monitoring of therapy, and achievement of TSH goals that are specific to the individual patient’s overall clinical situation. These goals are common not only to patients with a sole diagnosis of hypothyroidism, as discussed in the recent American Thyroid Association Guidelines, but also to patients with hypothyroidism in the setting of thyroid cancer. Several recent studies have illuminated our understanding of the benefits and risks of TSH suppression therapy in patients with differentiated thyroid cancer. Multiple studies of combination therapy with levothyroxine and liothyronine for treating hypothyroidism have not lead to a clear conclusion about its benefits over levothyroxine monotherapy. Animal studies have advanced our understanding of the altered serum and tissue milieu that characterizes levothyroxine monotherapy. Crossing the bridge from this translational research into clinical research using sustained release triiodothyronine preparations may ultimately enhance the health of our patients. Summary Continued refinement of our understanding of thyroid status and our ability to flawlessly implement thyroid hormone replacement is an active area of research.

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Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987–2012

Cited by 146 publications

References 41 publications

Thyroid Cancers: Considerations, Classifications, and Managements

Thyroid Cancers: Considerations, Classifications, and Managements

Timing of multikinase inhibitor initiation in differentiated thyroid cancer

Update on the treatment of hypothyroidism

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