title: The Treatment of Well-Differentiated Thyroid Carcinoma.
abstract: BACKGROUND
  Recent decades have seen a rise in the incidence of well-differentiated (mainly papillary) thyroid carcinoma around the world. In Germany, the age-adjusted incidence of well-differentiated thyroid carcinoma in 2010 was 3.5 per 100 000 men and 8.7 per 100 000 women per year.
  
  
  METHODS
  This review is based on randomized, controlled trials and multicenter trials on the treatment of well-differentiated thyroid carcinoma that were retrieved by a selective literature search, as well as on three updated guidelines issued in the past two years.
  
  
  RESULTS
  The recommended extent of surgical resection depends on whether the tumor is classified as low-risk or high-risk, so that papillary microcarcinomas, which carry a highly favorable prognosis, will not be overtreated. More than 90% of localized, well-differentiated thyroid carcinomas can be cured with a combination of surgery and radioactive iodine therapy. Radioactive iodine therapy is also effective in the treatment of well-differentiated thyroid carcinomas with distant metastases, yielding a 10-year survival rate of 90%, as long as there is good iodine uptake and the tumor goes into remission after treatment; otherwise, the 10-year survival rate is only 10%. In the past two years, better treatment options have become available for radioactive-iodine-resistant thyroid carcinoma. Phase 3 studies of two different tyrosine kinase inhibitors have shown that either one can markedly prolong progression-free survival, but not overall survival. Their more common clinically significant side effects are hand-foot syndrome, hypertension, diarrhea, proteinuria, and weight loss.
  
  
  CONCLUSIONS
  Slow tumor growth, good resectability, and susceptibility to radioactive iodine therapy lend a favorable prognosis to most cases of well-differentiated thyroid carcinoma. The treatment should be risk-adjusted and interdisciplinary, in accordance with the current treatment guidelines. Even metastatic thyroid carcinoma has a favorable prognosis as long as there is good iodine uptake. The newly available medical treatment options for radioactive-iodine-resistant disease need to be further studied.
authors.affiliation: Endocrinology and Nephrology Clinic, Leipzig University Hospital, Nuclear Medicine Clinic, Leipzig University Hospital, Clinic for Nuclear Medicine, University of Duisburg-Essen, Department of Nuclear Medicine, University Hospital of Würzburg and Klinik für Nuklearmedizin, Klinikum Augsburg, Department of General, Visceral and Vascular Surgery, University Hospital of Halle (Saale), Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital of Würzburg.
authors.forename: Ralf
authors.initials: R
authors.lastname: Paschke
authors.forename: Thomas
authors.initials: T
authors.lastname: Lincke
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Müller
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kreissl
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals