Overview of the management of differentiated thyroid cancer

Thyroid cancer is an uncommon tumor accounting for roughly 1% of all new malignancies. Differentiated (ie, papillary or follicular) thyroid carcinoma is usually asymptomatic, and frequently appears as a solitary thyroid nodule but few show cervical lymphadenopathy or metastasis to lung, bone, or liver. Fine needle aspiration (FNA) is recommended in the initial diagnostic test. Depending on the size of the lesion and other associated risk factors, most patients are treated with total or near total thyroidectomy. Postoperative radioiodine ablation is performed when tumor has a potential for recurrence. Recurrence rates and cancer-specific mortality is decreased by suppressing thyroid stimulating hormone (TSH). Long-term surveillance and follow-up with physical examination every 3 to 6 months for 2 years and then annually if patient remains cancer free. Whole body iodine scans are done every 12 months for follow-up until one negative scan (either withdrawal of thyroid hormone or rhodium complex -TSH). Thyroglobulin measurements (with antithyroglobulin antibodies) and ultrasound neck are suggested at 6 and 12 months and then annually if disease free.