Controversial Issues in Thyroid Cancer Management

Abstract

The lack of prospective randomized clinical trials for most management topics in differentiated thyroid cancer forces us to make management recommendations based on retrospective observational data, which are often incomplete, subject to selection bias, and conflicting. Therefore, it is not surprising that many aspects of thyroid cancer management remain controversial and not well defined. This review will examine the controversies surrounding 3 important topics in thyroid cancer management: the option of thyroid lobectomy as initial therapy, the use of preoperative neck imaging to optimize the completeness of the initial surgery, and the selective use of radioactive iodine for remnant ablation, adjuvant treatment, or treatment for known persistent or recurrent disease. As thyroid cancer management moves toward a much more risk-adapted approach to personalized recommendations, clinicians and patients must balance the risks and benefits of the potential options to arrive at a plan that is optimized regarding both patient preferences/values and the philosophy/experience of the local disease management team.

Keywords: radioactive iodine therapy; thyroid cancer; thyroid lobectomy.

FIGURE 1.

Factors that make interpretation of the current literature difficult. Multiple factors make it difficult to use numerous retrospective, observational studies to arrive at definite conclusions on optimal use of RAI therapy. (Adapted from Sacks et al. (30).)