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01 December 2005

Current management of differentiated thyroid carcinoma.

Gelsy Lupoli, Francesco Fonderico, Sara Colarusso, Annalisa Panico, Annalisa Cavallo, Lucia Di Micco, Angela Paglione, Luisa Costa, Giovanni Lupoli

Med Sci Monit 2005; 11(12): RA368-373 :: ID: 438949

Abstract

Papillary and follicular thyroid cancers, together termed differentiatedthyroid cancers (DTC), comprise the majority of thyroid carcinomas and have an optimal prognosis. MostDTCs appear as asymptomatic thyroid nodules. Fine-needle aspiration (FNA) cytology is the first diagnostictest for a thyroid nodule in a euthyroid patient. Surgery is the primary treatment for thyroid cancers.Most clinicians recommend near-total or total thyroidectomy, and then [sup]131[/sup]I ablation therapy, sinceits consequences are minimal and follow-up is facilitated. A total body scan (TBS) is performed 4 to7 days after [sup]131[/sup] I treatment. At a later stage, all patients should be treated with L-tiroxine so asto suppress TSH, and must undergo a periodic evaluation of TSH and thyroglobulin (Tg), the most sensitiveand specific marker of DTC. After 6-12 months, TBS with [sup]131[/sup]I is performed, a technique complementaryto serum Tg evaluation. For this technique, it is also necessary to have a high serum TSH concentration,obtained by withdrawing thyroxine therapy for 4 to 6 weeks. This standard method induces hypothyroidism.An alternative method to the withdrawal of thyroid hormones in the follow-up of DTC patients is to administerrecombinant human TSH (rh-TSH). After the dose of rhTSH, [sup]131[/sup]I is administered, and then TBS can beperformed 48-72 hours later. Currently, several authors have explored the possibility that rh-TSH-stimulatedTg levels may represent the only necessary test to differentiate patients with persistent disease fromdisease-free patients, without performing a diagnostic TBS.

Keywords: Carcinoma - therapy, Risk Factors, Thyroid Neoplasms - therapy

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