A paradigm shift in the management of differentiated thyroid cancer

Abstract

This book refines the risk stratification and surgical planning of patients suspected for or diagnosed with differentiated thyroid cancer in an era of de-escalative management. With the sharp rise in incidence of differentiated thyroid cancer, predominantly due to low risk disease, there is a global trend towards less aggressive treatment. These include hemithyroidectomy or active surveillance where total thyroidectomy, RAI and thyroid suppression was commonplace. Worldwide, this change in management is currently at different stages as illustrated in chapter 2. To minimize treatment-related morbidity and unnecessary therapy, adequate risk stratification of DTC is needed. This is a complex and dynamic process which makes caring for patients with DTC exciting. In this book we give specific recommendations to further define thyroid malignancy risks for subgroups such as MEN1 patients in chapter 4, to those with entities not considered to be cancer in chapter 5 & 6 and to those with tall cell variants of PTC in chapter 8. In chapter 9 we show the influence of extent of surgery on the long-term quality of life of low-risk DTC. Next, we highlighted the need for further research on topics such as the follow-up of benign thyroid nodules in chapter 3 and the influence of preoperative CT in chapter 7.