Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer

Abstract

The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries. Arq Bras Endocrinol Metab. 2009;53(7):884-97. KeywordśThyroid cancer; thyroid ultrasonography; radioiodine therapy; thyroglobulin; consensus RESUMO Estas recomendações tiveram por objetivo o desenvolvimento de diretrizes para avaliação e manejo de pacientes com câncer diferenciado da tiroide em países latino-americanos. Um painel composto por 13 membros da Sociedade Latino-Americana de Tireoide (SLAT) -que estavam envolvidos em pesquisas, e eram peritos no cuidado do paciente com câncer da tiroide e provenientes de diferentes centros médicos latino-americanos -utilizou os princípios da Medicina Baseada em Evidências para produzir esse consenso. Após uma primeira reunião, um texto inicial foi elaborado, baseado em evidências e opiniões dos especialistas do painel e, posteriormente, circulado entre os membros do painel, para revisão. Após a revisão, o documento foi enviado aos membros da SLAT para comentários e considerações e, finalmente, revisado e refinado pelos autores. As recomendações finais aqui apresentadas demonstram o estado da arte no manejo do câncer diferenciado da tireoide aplicadas aos países latino-americanos.Arq InTRODUCTIOn T he risk of malignancy in a thyroid nodule varies between 5% and 10% in iodine sufficient countries, and the amount of iodine supplemented in table salt influences on the morphology of the malignant tumor types (1).

Response to sorafenib treatment in advanced metastatic thyroid cancer

“…if trials are not available (7,8), but the practical details of managing these patients often vary between physicians and countries (9).…”

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

“…The present study was conducted to answer this question. The criterion used for the definition of LN status (preoperative US and intraoperative inspection by the surgeon) agrees with current guidelines since there is no clear indication for elective LN dissection in patients with tumors ≤ 4 cm and without apparent extrathyroid invasion (1)(2)(3)(4)(5)(6)(7)23). …”

“…Although the impact on the prognosis is questionable, the presence of clinically apparent LNM [cN1, defined as LNM identified by preoperative physical examination or ultrasonography (US), or intraoperative inspection by the surgeon] excludes the patient from the group of low recurrence risk (1)(2)(3)(4)(5)(6) and frequently indicates a more aggressive initial approach (1)(2)(3)(4)(5)(6)(7)(8).…”

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

“…Descritores Níveis de tiroglobulina indetectáveis; tireoglobulina; câncer; tiroide INTRODUCTION S erum thyroglobulin (Tg) is usually used as a post--surgical marker to define disease status in patients with differentiated thyroid cancer (1,2). Up to 20% of patients may present Tg-Antibodies (TgAb), which might obscure the evidence of detectable Tg (3,4).…”

“…Up to 20% of patients may present Tg-Antibodies (TgAb), which might obscure the evidence of detectable Tg (3,4). TgAb are also considered as surrogate markers for the persistence of disease (1,2,(6)(7)(8).…”