Contemporary Challenges in the Management of Thyroid Cancer
May 2011
Volume 2, Issue 1

Introduction

Welcome from Mira Milas, MD

In this edition of EndoScan, we will focus on the topic of thyroid cancer. We have included six abstracts that address a variety of contemporary challenges in the management of thyroid cancer patients. A commentary section follows each abstract.

Why These Articles Were Chosen

Thyroid cancer is the most common endocrine malignancy. The incidence rates of thyroid cancer have consistently increased, especially among women, over the last 10 to 20 years. A number of diagnostic and treatment innovations are entering clinical practice, and awareness of these is worthwhile. Likewise, some topics remain controversial and deserve ongoing consideration. Finally, these articles highlight practical clinical pearls that can make a difference in the care of a patient with thyroid nodules or thyroid cancer.

Take Home Messages

  • A thyroid nodule must be described in detail on an ultrasound report. Ultrasound features that can affect the interpretation of fine-needle aspiration biopsy results are highlighted and may warrant repeat biopsy.
  • Robot-assisted surgery to remove benign thyroid and parathyroid tumors is feasible, but has strict patient and surgeon-selection criteria. It is a promising new technology that requires further evaluation for use in patients in the United States.
  • Risk-stratification of thyroid cancer patients is an important new buzzword in both the endocrinology and thyroid surgery fields. It reflects a strategy of individualized care of the thyroid cancer patient based on expected prognosis. Rather than a “one-shoe-fits-all-sizes” strategy, risk-stratification aims to optimize benefits and limit risks associated with thyroid cancer therapy.
  • Prophylactic central neck dissection for papillary thyroid cancer remains controversial. New studies provide insight into potential benefits but have not yet identified a patient subgroup in whom this procedure could be uniformly or consistently performed.
  • Molecular markers are becoming available and accepted in routine clinical practice to improve diagnosis of indeterminate thyroid nodules and guide extent of initial thyroid surgery.
  • The era of personalized medicine advocates that patients with known familial syndromes that carry higher risk of thyroid cancer be screened for underlying thyroid disease. Those with known thyroid cancer and suspected hereditary etiology require genetic counseling.
First Article:
Value of US Correlation of a Thyroid Nodule with Initially Benign Cytologic Results
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