Recurrent Differentiated Thyroid Cancer
Endocrine Practice, 08/14/2012
Shaha AR – Management of patients with recurrent thyroid cancer necessitates a true multidisciplinary approach. These patients require close follow–up, with cross–sectional imaging and positron emission tomographic scanning in selected individuals.Methods
- Common risk factors associated with recurrent thyroid cancer are outlined, and appropriate management strategies are reviewed.
- The overall prognosis in patients with differentiated thyroid cancer is excellent.
- Factors associated with recurrent thyroid cancer include extrathyroidal extension of the primary tumor, bulky nodal metastatic lesions, macroscopic local invasion, and aggressive histologic subtypes.
- The locoregional recurrence and mortality are higher in patients with high-risk thyroid cancers.
- Patients initially presenting with locally aggressive and advanced thyroid cancer have a higher incidence of recurrent disease in the thyroid bed or nodal metastasis.
- These patients also have a high incidence of distant metastatic lesions.
- Locally recurrent thyroid cancer may be seen in more than 25% of patients with aggressive differentiated thyroid cancer.
- Recurrent disease in the thyroid bed can be a difficult problem to manage because of the proximity of the tumor to the recurrent laryngeal nerve, visceral structures in the central compartment, and occasional involvement of the trachea or larynx.
- External beam radiation therapy after surgical treatment may be important for better local control in the thyroid bed region, especially in patients with poorly differentiated histologic features.
- The role of additional radioiodine therapy remains undefined at this stage.