From the Research
The Orpha code for Differentiated Thyroid Carcinoma is ORPHA146, and management should be personalized based on risk stratification, with a focus on reducing unnecessary burden for patients with low-risk disease. Differentiated thyroid carcinoma (DTC) is the most common type of thyroid cancer, accounting for approximately 90% of all thyroid malignancies, and includes papillary thyroid carcinoma, follicular thyroid carcinoma, and Hürthle cell carcinoma 1. These cancers are characterized by their ability to maintain some degree of normal thyroid cell function, including iodine uptake, which makes them generally more treatable and associated with better prognosis compared to undifferentiated thyroid cancers.
Key Considerations in Management
- Management typically involves surgical resection (total or partial thyroidectomy), possibly followed by radioactive iodine therapy depending on risk stratification 2.
- Patients require lifelong thyroid hormone replacement therapy after total thyroidectomy, with TSH suppression often recommended to prevent recurrence.
- Regular monitoring with thyroglobulin levels, neck ultrasound, and other imaging modalities is essential for surveillance.
- The approach towards management of DTC has undergone a critical appraisal, with a focus on reducing the unnecessary burden for patients with very low risk DTC and the correct identification of those who require treatment that is more intensive and/or follow-up 3.
Recent Developments and Recommendations
- Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of nonspecialist physicians, including general endocrinologists and medical oncologists at large 1.
- A three-tiered system classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease, and risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution 1.
- In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents 4.