title: New treatments and shifting paradigms in differentiated thyroid cancer management.
abstract: BACKGROUND
  Although most thyroid cancer patients have an excellent prognosis, 10% of low-risk cancers and 25% of high-risk cancers recur, with mortality rates in excess of 50% at 3 years for aggressive thyroid cancer. Traditional paradigms including surgery, I¹³¹ ablation, and TSH suppression do not offer additional therapeutic options for cancers that fail these interventions. Risk stratification and outcomes data are shifting the treatment paradigms to favor more individualized therapies based on risk, and new treatment targets have been identified with promise to treat more aggressive thyroid cancer.
  
  
  METHODS
  The authors review the recent literature and published guidelines on thyroid cancer and summarize changing management paradigms and treatments of thyroid cancer.
  
  
  RESULTS
  Outcomes data and risk stratification have promoted changes to traditional paradigms. Total/near-total thyroidectomy improves outcomes in both recurrence and mortality. Central compartment lymph node dissection facilitates nodal status determination and likely improves outcomes, while low-risk patients with small tumors are not likely to benefit from I¹³¹ remnant ablation. Early-phase studies have demonstrated significant improvement in progression-free survival with multikinase inhibitors targeting MAPK and angiogenic pathways.
  
  
  CONCLUSIONS
  Risk stratification and outcomes data have modified treatment paradigms in thyroid cancer. Patients with progressive thyroid cancer that is no longer surgically resectable or iodine avid should be considered for treatment with multikinase inhibitors, preferably by enrollment in a therapeutic treatment trial.
authors: Endocrine tumor Program, Moffitt Cancer Center, Tampa, FL 33612, USA. Bradford. Carter@moffitt.org
authors: W Bradford
authors: WB
authors: Carter
authors: John B
authors: JB
authors: Tourtelot
authors: Jason G
authors: JG
authors: Savell
authors: Howard
authors: H
authors: Lilienfeld
mesh_terms: D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D012306:Risk; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes; D047428:Protein Kinase Inhibitors