Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Resection of Unresectable Stage IVB Thyroid Cancer Encasing the Carotid Artery

“…Surgery was uneventful and histopathology was papillary thyroid cancer with anaplastic dedifferentiation and 22/44 lymph nodes positive for metastasis. Final diagnosis was T4bN1bM0-stage IVB.Stage IVB includes a differentiated thyroid cancer (DTC) with either encasement of the carotid artery or infiltration of the prevertebral fascia and mediastinal vessels [1]. In our case, the tumour along with jugular lymph nodal mass had encased the common carotid artery on the left side, though usually structures like the carotid sheath and oesophagus are less vulnerable to invasion.…”

Evolution in the surgical management of well‐differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment

“…The 2009 American Thyroid Association Guidelines [1] includes the following recommendations: (1) ''Therapeutic central-compartment (level VI) neck dissection for patients with clinically involved central or lateral neck lymph nodes should accompany total thyroidectomy to provide clearance of disease from the central neck. (2) Prophylactic central-compartment neck dissection (ipsilateral or bilateral) may be performed in patients with papillary thyroid carcinoma with clinically uninvolved central neck lymph nodes, especially for advanced primary tumors (T3 or T4).…”

“…The yet outstanding and relevant modern questions that still need to be addressed include: (1) what is the predictive value of a central lymph node dissection in terms of recommendations for adjuvant radioiodine treatment? and (2) what is the long-term impact of routine, prophylactic central lymph node dissection?…”

Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma

“…For example, in a survey from North America [2] the majority of physicians are convinced that RRA decreases DTC-related mortality and recurrence, and facilitates DTC follow-up with a low risk of adverse effects. RRA has been adopted as an integral part of several recent international guidelines for the treatment of DTC, such as those of the American Thyroid Association [3], the European Thyroid Association [4], and the European Association of Nuclear Medicine [5], as well as several national guidelines in countries such as the UK, Germany [6,7], the Netherlands and Austria.…”

“…They also highlight the problem in comparing such studies in terms of outcome: in the various studies different 'staging' systems were used, in which the lowest risk stages varied widely. Therefore recent internationally acclaimed guidelines and consensus statements [3,4,21,22] at least clearly categorize patients who should not, who might, and who should receive RRA treatment according to the (pathological) extension of the disease. In a further development of staging, even RRA treatment itself may facilitate staging and further follow-up of DTC.…”