title: Current management of differentiated thyroid carcinoma.
abstract: Papillary and follicular thyroid cancers, together termed differentiated thyroid cancers (DTC), comprise the majority of thyroid carcinomas and have an optimal prognosis. Most DTCs appear as asymptomatic thyroid nodules. Fine-needle aspiration (FNA) cytology is the first diagnostic test for a thyroid nodule in a euthyroid patient. Surgery is the primary treatment for thyroid cancers. Most clinicians recommend near-total or total thyroidectomy, and then 131I ablation therapy, since its consequences are minimal and follow-up is facilitated. A total body scan (TBS) is performed 4 to 7 days after 131I treatment. At a later stage, all patients should be treated with L-tiroxine so as to suppress TSH, and must undergo a periodic evaluation of TSH and thyroglobulin (Tg), the most sensitive and specific marker of DTC. After 6-12 months, TBS with 131I is performed, a technique complementary to serum Tg evaluation. For this technique, it is also necessary to have a high serum TSH concentration, obtained by withdrawing thyroxine therapy for 4 to 6 weeks. This standard method induces hypothyroidism. An alternative method to the withdrawal of thyroid hormones in the follow-up of DTC patients is to administer recombinant human TSH (rh-TSH). After the dose of rhTSH, 131I is administered, and then TBS can be performed 48-72 hours later. Currently, several authors have explored the possibility that rh-TSH-stimulated Tg levels may represent the only necessary test to differentiate patients with persistent disease from disease-free patients, without performing a diagnostic TBS.
authors.affiliation: Department of Molecular and Clinical Endocrinology and Oncology, Faculty of Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Gelsy Arianna
authors.initials: GA
authors.lastname: Lupoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Fonderico
authors.forename: Sara
authors.initials: S
authors.lastname: Colarusso
authors.forename: Annalisa
authors.initials: A
authors.lastname: Panico
authors.forename: Annalisa
authors.initials: A
authors.lastname: Cavallo
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Angela
authors.initials: A
authors.lastname: Paglione
authors.forename: Luisa
authors.initials: L
authors.lastname: Costa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lupoli
mesh_terms: D002277:Carcinoma / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*