title: Differentiated thyroid carcinoma: defining new paradigms for postoperative management.
abstract: The demography of differentiated thyroid cancers (DTCs) has changed considerably since the 1990s, when the vast majority of these tumors were clinically evident at the time of diagnosis, and many were associated with regional lymph node involvement. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms that are discovered incidentally, during neck imaging procedure performed for other reasons or during postoperative assessment of a gland removed for benign nodular goiter. The tools available for diagnosing, treating, and monitoring DTCs have also changed and their diagnostic capacities have increased. For these reasons, DTC treatment and follow-up paradigms are being revised to ensure more appropriate, cost-effective management of the current generation of DTCs. This review examines some of the key issues in this area, including the assessment of risks for disease recurrence and thyroid cancer-related death, the indications for postoperative ablation of the thyroid remnant with radioactive iodine and TSH-suppressive doses of levothyroxine, the pros, cons, and rationales for the use of various follow-up tools (serum thyroglobulin assays, neck ultrasound, 2-[18F]fluoro-2-deoxyglucose-positron emission tomography, and whole-body (131)I scintigraphy), and temporal strategies for maximizing their efficacy. An algorithm is presented for individualized, risk-tailored management of DTC patients.
authors.affiliation: Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Durante
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costante
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
mesh_terms: D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D011184:Postoperative Period; D012306:Risk; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013972:Thyrotropin / Q000037:antagonists & inhibitors
chemical_list: D007457:Iodine Radioisotopes; D013972:Thyrotropin
keywords: differentiated thyroid carcinoma; follow-up; neck ultrasound; radioiodine remnant ablation; recurrence; thyroglobulin