From the Guidelines
The treatment of Differentiated Thyroid Cancer (DTC) typically includes a multimodal approach consisting of surgery, radioactive iodine therapy, thyroid hormone therapy, and ongoing surveillance. Surgery is the primary treatment, usually involving total thyroidectomy (complete removal of the thyroid gland) and sometimes removal of nearby lymph nodes if cancer has spread. Following surgery, radioactive iodine therapy (RAI) with I-131 may be administered to destroy any remaining thyroid tissue or cancer cells, with doses typically ranging from 30-200 mCi depending on disease extent, as recommended by the most recent guidelines 1. Thyroid hormone therapy with levothyroxine (typically starting at 1.6-1.8 mcg/kg/day) serves dual purposes: replacing the hormone no longer produced by the removed thyroid and suppressing thyroid-stimulating hormone (TSH) to prevent stimulation of any remaining cancer cells. Ongoing surveillance includes regular physical examinations, thyroglobulin level monitoring (a tumor marker), neck ultrasounds, and occasionally whole-body scans or other imaging. This comprehensive approach is effective because DTC cells typically retain many normal thyroid cell functions, including iodine uptake and responsiveness to TSH suppression. Treatment intensity varies based on individual risk stratification, with higher-risk patients requiring more aggressive therapy and closer monitoring, as outlined in the guidelines 1.
Some key points to consider in the treatment of DTC include:
- The use of recombinant human TSH (rhTSH) to prepare patients for radioiodine ablation, which has been shown to be highly effective and safe 1.
- The importance of maintaining a low-normal TSH level (0.5-2 mIU/ml) in patients with low-risk DTC, and a suppressed TSH level (0.1-0.5 mIU/ml) in patients with high-risk DTC or biochemical incomplete/ineterminate responses to treatment 1.
- The role of targeted therapy in the treatment of advanced DTC, including the use of kinase inhibitors such as lenvatinib, vandetanib, and cabozantinib, which have shown efficacy in patients with metastatic DTC 1.
Overall, the treatment of DTC requires a multidisciplinary approach, with careful consideration of individual patient risk factors and responses to therapy.
From the FDA Drug Label
1.3 Differentiated Thyroid Carcinoma Sorafenib tablets are indicated for the treatment of patients with locally recurrent or metastatic, progressive, differentiated thyroid carcinoma (DTC) that is refractory to radioactive iodine treatment.
Treatment of Differentiated Thyroid Cancer (DTC) includes:
- Sorafenib tablets for patients with locally recurrent or metastatic, progressive, DTC that is refractory to radioactive iodine treatment 2
- Lenvatinib for the treatment of adult patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory DTC 3
From the Research
Treatment of Differentiated Thyroid Cancer (DTC)
The treatment of DTC typically includes:
- Surgery, which may involve near-total or total thyroidectomy 4, 5, 6
- Radioiodine therapy, which is used to ablate any remaining thyroid tissue and treat metastases 4, 7, 8, 6
- Levothyroxine substitution, which is used to replace thyroid hormone and suppress thyroid-stimulating hormone (TSH) levels 4, 5, 6
Additional Treatment Options
In cases where the cancer is resistant to radioiodine therapy, additional treatment options may be considered, including:
- Strict suppression of TSH levels 4
- External local radiotherapy 4
- Targeted therapies, such as tyrosine kinase inhibitors (TKIs) 7, 8
- Immunotherapy 6
- Multikinase inhibitors 4
Considerations for Treatment Selection
The selection of treatment for DTC depends on various factors, including: