Management of thyroid nodules and surgery for differentiated thyroid cancer.
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades. Whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains unclear. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients. Level 1 evidence is lacking, and there are limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. This overview focuses on the major issues associated with the investigation of thyroid nodules and the extent of surgery. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. The onus is on the physician to avoid treatment-related complications from thyroid surgery and to offer the most efficient and cost-effective therapeutic option.
Iyer
N G
NG
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York 10065, USA.
Shaha
A R
AR
D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy
Ann Surg Oncol. 2007 Nov;14(11):3210-5
17713821
JAMA. 2006 May 10;295(18):2164-7
16684987
J Ultrasound Med. 2003 Oct;22(10):1027-31
14606557
Int J Cancer. 1991 Apr 22;48(1):28-33
2019455
Laryngoscope. 2000 Feb;110(2 Pt 1):183-93
10680914
Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S92-7
17848306
Ann N Y Acad Sci. 2008 Sep;1138:58-64
18837884
Ann Thorac Surg. 1992 Jul;54(1):3-9; discussion 9-10
1610250
J Am Coll Surg. 2008 Aug;207(2):259-64
18656056
J Clin Endocrinol Metab. 1999 Jan;84(1):24-8
9920057
Thyroid. 2009 Jul;19(7):683-9
19583485
Int Surg. 2006 Jul-Aug;91(4):237-44
16967687
Ann Surg. 2008 Jun;247(6):1082-3; author reply 1083-4
18520248
Head Neck. 2009 Sep;31(9):1152-63
19360746
World J Surg. 2008 Jul;32(7):1264-8
18305991
Am J Surg. 1993 Oct;166(4):331-5
8214286
J Natl Compr Canc Netw. 2007 Jul;5(6):623-30
17623613
J Clin Endocrinol Metab. 2006 Feb;91(2):498-505
16303836
J Surg Oncol. 2006 Dec 15;94(8):683-91
17131422
Thyroid. 2009 Dec;19(12):1351-61
19895341
World J Surg. 2008 Nov;32(11):2494-502
18784956
AJR Am J Roentgenol. 2002 Mar;178(3):687-91
11856699
Otolaryngol Clin North Am. 1998 Oct;31(5):823-31
9735110
Int J Surg. 2005;3(3):213-20
17462286
Am J Surg. 1992 Dec;164(6):658-61
1463119
Br J Cancer. 1993 Feb;67(2):330-40
8431362
Ultrasound Q. 2006 Dec;22(4):231-8; discussion 239-40
17146329
Thyroid. 2009 Nov;19(11):1167-214
19860577
Ann Surg. 2007 Sep;246(3):375-81; discussion 381-4
17717441
J Clin Endocrinol Metab. 2002 May;87(5):1941-6
11994321
J Ultrasound Med. 2007 Oct;26(10):1367-71
17901140
Laryngoscope. 2009 Jun;119(6):1135-9
19358241
Cancer. 1998 Dec 15;83(12):2638-48
9874472
Curr Opin Otolaryngol Head Neck Surg. 2005 Apr;13(2):112-6
15761287
Endocr Pract. 2002 Jul-Aug;8(4):282-6
12185993