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How Should Well Differentiated Thyroid Cancer with Distant Metastatic Disease Be Managed?

  • Tanaz VaghaiwallaEmail author
  • Peter Angelos
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

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.

Keywords

Well differentiated thyroid cancer Thyroid metastases Survival 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Endocrine Surgery Program, Department of SurgeryThe University of Chicago MedicineChicagoUSA

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