What is the recommended treatment for a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)?

From the Guidelines

The recommended treatment for a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is surgical excision, typically a lobectomy (removal of the affected thyroid lobe). This approach is considered sufficient for most NIFTP cases as these lesions have a very low risk of recurrence or metastasis, as indicated by the low estimated risk of recurrence of <1% 1. Following surgery, patients generally do not require radioactive iodine therapy, which is often used for more aggressive thyroid cancers. Long-term monitoring with periodic clinical examinations and thyroid function tests is recommended, though the follow-up regimen is less intensive than for malignant thyroid cancers.

Key Considerations

• NIFTP represents a reclassification of certain thyroid nodules that were previously categorized as follicular variant of papillary thyroid carcinoma but are now recognized to have an indolent clinical course 1.
• The reclassification acknowledges that these lesions lack the invasive features and metastatic potential of true thyroid cancers, allowing for less aggressive management while still ensuring complete removal of the lesion.
• The use of lobectomy for NIFTP is supported by guidelines, including those from the National Comprehensive Cancer Network (NCCN) 1 and the European Society for Medical Oncology (ESMO) 1.
• Molecular testing, such as assessment of BRAF mutations, may be useful in the diagnosis and management of thyroid nodules, but is not necessary for NIFTP diagnosis 1.

Prognosis and Quality of Life

• The prognosis for patients with NIFTP is excellent, with a very low risk of recurrence or metastasis 1.
• The quality of life for patients with NIFTP is generally good, with minimal long-term consequences following surgical treatment.
• Long-term monitoring is necessary to ensure that the patient remains free of disease, but the follow-up regimen is less intensive than for malignant thyroid cancers.

From the Research

Prognosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP)

• The prognosis for NIFTP is generally favorable, with a low risk of recurrence and distant metastasis 2, 3, 4.
• Studies have shown that NIFTP carries a low risk of adverse oncologic events, with no tumor recurrences or metastases reported in some cohorts 2, 4.
• The American Thyroid Association (ATA) guidelines suggest that NIFTP is a low-risk tumor, and management strategies should be tailored accordingly 2, 3, 4.

Treatment Options for NIFTP

• The recommended treatment for NIFTP is typically lobectomy, with postoperative monitoring of thyroglobulin levels and performing neck ultrasounds 3.
• Some studies suggest that completion thyroidectomy or radioactive iodine therapy may not be necessary for patients with NIFTP, reducing the risk of overtreatment 2, 4.
• The decision to perform total thyroidectomy or administer radioactive iodine therapy should be based on individual patient factors, such as the presence of other nodules or aberrant preoperative thyroid function 2.
• Molecular testing on fine-needle aspiration specimens may be useful in preoperative diagnosis and management of NIFTP, helping to distinguish it from other thyroid tumors 5.

Factors Associated with Extent of Surgery

• Studies have identified factors associated with the extent of surgery, including Bethesda category by fine-needle aspiration (FNA), presence of other nodules, and aberrant preoperative thyroid function 2.
• Multivariable regression analysis has shown that Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts total thyroidectomy 2.
• Patients with NIFTP who undergo hemithyroidectomy may not require completion thyroidectomy or radioactive iodine therapy, with no recurrence or metastases reported in some cohorts 2, 4.