Differentiated thyroid cancer: "Complete" rational approach

Controversy continues regarding the optimal management of patients with dif ferentiated thyroid cancer because no prospective randomized studies evalua ting the merits of (1) extent of thyroidectomy, (2) postoperative radioacti ve iodine ablation, or (3) thyroid-stimulating hormone (TSH) suppressive th erapy exist. Patients with low risk differentiated thyroid cancer enjoy a r elatively good prognosis,vith a mortality rate of about 2% to 5% and a recu rrence rate of about 20%. Despite the excellent prognosis in patients consi dered to be at low risk, total or near-total thyroidectomy in patients with differentiated thyroid cancer has the advantages that: (1) postoperative r adioactive iodine can be used to detect and treat residual normal thyroid t issue and local or distant metastases; (2) follow-up serum thyroglobulin le vels are a more sensitive marker of persistent or recurrent disease when al l thyroid tissue has been removed; and (3) total or near-total thyroidectom y,vith postoperative I-131 ablation and TSH suppressive therapy is associat ed with better survival and lower recurrence rates. Patients with occult pa pillary thyroid cancer and minimally invasive follicular thyroid cancer can be treated by thyroid lobectomy because they have a near-normal life expec tancy. Virtually all other patients with differentiated thyroid cancer appe ar to benefit from more extensive initial treatment.