From the Guidelines
Thyroid cancer is a serious but often treatable condition that requires prompt medical attention, and the most effective treatment approach typically involves surgical removal of the thyroid gland (total thyroidectomy), often followed by radioactive iodine therapy to destroy any remaining cancer cells, as recommended by the most recent and highest quality study 1.
Diagnosis and Treatment Approach
The diagnosis of thyroid cancer should involve thyroid ultrasound (US) supplemented by fine needle aspiration cytology (FNAC) as a first-line diagnostic procedure, and serum calcitonin (CT) measurement should be an integral part of the diagnostic evaluation of thyroid nodules, especially for medullary thyroid cancer 1.
Key Treatment Components
- Total or near-total thyroidectomy is the initial treatment for differentiated thyroid carcinoma (DTC) whenever the diagnosis is made before surgery, with less extensive surgical procedures considered in specific cases 1.
- Radioactive iodine therapy is recommended for high-risk patients and for ablating any remnant thyroid tissue and potential microscopic residual tumor, with the method of choice for preparation being the administration of recombinant human TSH (rhTSH) while the patient is on levo-thyroxine (LT4) therapy 2.
- Lifelong thyroid hormone replacement therapy (e.g., levothyroxine) is necessary after surgery, with typical starting doses of 1.6-1.8 mcg/kg body weight per day, and TSH suppressive treatment with LT4 is of benefit in high-risk thyroid cancer patients 3.
Follow-up and Monitoring
Regular follow-up appointments and blood tests to monitor thyroid hormone levels and check for cancer recurrence are crucial, with the subsequent follow-up of patients considered free of disease consisting of physical examination, basal serum Tg measurement on LT4 therapy, and neck US once per year 1.
Additional Treatments
In some cases, additional treatments like external beam radiation therapy or targeted drug therapies (e.g., sorafenib, lenvatinib) may be recommended, especially for patients with unresectable disease or persistent locoregional disease after surgery 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Differentiated Thyroid Cancer LENVIMA is indicated for the treatment of adult patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC).
Levothyroxine sodium tablets are a L-thyroxine (T4) indicated in adult and pediatric patients, including neonates, for: • Pituitary Thyrotropin (Thyroid‑Stimulating Hormone, TSH) Suppression: As an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer
The diagnosis of thyroid carcinoma (thyroid cancer) is not directly stated in the provided drug labels. The treatment of thyroid carcinoma (thyroid cancer) includes:
- LENVIMA (lenvatinib) for the treatment of adult patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC) 4
- Levothyroxine sodium as an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer 5
From the Research
Diagnosis of Thyroid Carcinoma
- Thyroid cancer is divided into several main types, with papillary thyroid cancer being the most common, accounting for approximately 84% of all thyroid cancers 6
- The diagnosis of thyroid cancer often involves imaging studies, including ultrasounds, computed tomography, magnetic resonance imaging, and positron emission tomography scans that incidentally detect thyroid nodules 7
- Ultrasound (US) is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis 8
- Nuclear imaging modalities, such as radioiodine imaging, FDG imaging, and somatostatin receptor imaging, play an important role in the evaluation of thyroid cancer 9
Treatment of Thyroid Carcinoma
- The treatment options for patients with thyroid cancer include the surgical removal of the entire thyroid gland (total thyroidectomy), radioactive iodine therapy, and molecular-targeted therapies with tyrosine kinase inhibitors 7
- For microcarcinomas (≤1 cm), observation without surgical resection can be considered, while for tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases 6
- Surgical resection is the preferred approach for patients with recurrent locoregional disease, and for metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy 6
- Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65% 6
- Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma 6
Management and Staging of Thyroid Carcinoma
- The management of thyroid cancer requires a multidisciplinary approach, including head and neck/endocrine surgeons, endocrinologists, oncologists, and radiologists 10
- The radiographic evaluation of thyroid cancer is critical for complete and precise staging and affects the surgical approach to address these cancers 10
- The eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) is used for staging thyroid carcinomas 8
- Management guidelines based on international consensus recommendations, including the role of radioiodine scan, are used to guide treatment decisions 8