[The initial treatment of patients with differentiated thyroid carcinoma; consensus and controversies]

Differentiated thyroid carcinoma has a low incidence and a relatively good prognosis. As a consequence, treatment protocols are largely based on retrospective analyses of heterogeneous patient groups, as no randomised controlled trials with residual disease and survival as outcome measures are available. In the Netherlands, guidelines for initial therapy are based on a 1987 international consensus meeting. These guidelines involve near-total thyroidectomy with a few exceptions and routine radioiodide ablative therapy in all cases. Recent publications still support the main measures as advised in this consensus. Although randomised trials have not proven that the consensus guidelines improve the prognosis in thyroid carcinoma, the guidelines provide a base for uniform data collection and thus scientific research. They also provide tools for health-practice quality surveys.