How Should Well Differentiated Thyroid Cancer with Distant Metastatic Disease Be Managed?
Well differentiated thyroid cancer (WDTC) usually presents with cancer confined to the thyroid gland with or without spread to regional lymph nodes of the central or lateral neck. The patients with thyroid cancer who present with distant metastatic disease have worse outcomes including higher morbidity and mortality. Distant metastatic disease can be divided into metastatic pulmonary disease and metastatic extra-pulmonary disease, which can include primarily skeletal and brain disease. The purpose of this chapter was to review the current recommendations for managing patients with WDTC with distant metastatic disease at initial diagnosis and to present institutional experience. An aggressive management strategy is recommended by national and international guidelines which includes locoregional control with surgical intervention and postoperative radioactive iodine treatment. Institutional practice at our facility is to resect all detectable disease by performing total thyroidectomy and locoregional control with central and lateral neck lymph node dissection when indicated. Surgical resection of distant metastasis is recommended when the lesion is amenable to surgical intervention and when the patient performance status is amenable for undergoing the intervention. Radioactive iodine therapy is recommended for avid lesions, whereas non-avid lesions are a therapeutic dilemma and an area of research interest.
KeywordsWell differentiated thyroid cancer Thyroid metastases Survival
- 1.Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;11:1167–94.CrossRefGoogle Scholar
- 2.Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;1:1–133.CrossRefGoogle Scholar
- 7.Durante C, Haddy E, Leboulleux D, Hartle JP, Travagli B, Caillou M, Ricard JD, Lumbroso F, De Vathaire F, Schlumberger M. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metabol. 2006;91(8):2892–9.CrossRefGoogle Scholar
- 10.Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ, DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014;384(9940):319–28.CrossRefGoogle Scholar