The management of differentiated thyroid cancer (DTC) has been reviewed in the recently updated by the American Thyroid Association this year, updating the last guidelines from 2015. This talk will cover the initial evaluation and staging, the surgical approach, adjuvant therapies, monitoring, and management of subsequent recurrent disease particularly radioactive iodine refractory (RAIR) disease.
Though there has been an increase in thyroid cancer in the years leading to the previous guideline, the incidence has plateaued in the past few years, due to successful de-escalation of over treatment of low risk disease. There has been a number of new histological subtypes including non invasive follicular tumours with papillary like nuclear features (NIFTP) which are now included in the initial staging. Initial management includes review of the pre operative imaging, molecular testing where possible, and consideration of active surveillance or thyroidectomy. The DATA (Diagnosis, Assessment, Treatment, and Assessment) Framework has been utilised in the management of initial disease, persistent or recurrent disease, and RAIR. The estimated risk of structural recurrence can be estimated at initial review depending on the specific histological subtype, lymphovascular invasion, extrathyroidal extension, and distant metastases, in order to balance the potential for recurrence and residual disease with the adverse effect of a more aggressive initial approach. Tyrosine kinase treatment has revolutionised the care for patients with metastatic disease. Generic VEG-F therapy will be discussed in addition to the benefits of targeted therapy when the molecular driver is identified.