University of the Philippines – Philippine General Hospital Revised Clinical Practice Guidelines for the Management of Well-Differentiated Thyroid Carcinoma of Follicular Cell Origin
Abstract
In an effort to unify treatment approaches to patients with well-differentiated thyroid cancer of follicular cell origin, the Section of Endocrinology, Section of Nuclear Medicine, Department of Surgery, and Department of Otorhinolaryngology of the Philippine General Hospital formulated and published a clinical practice guideline on the management of well-differentiated thyroid cancer in 2008. In recognition of the new literature on thyroid cancer, as well as the questions that have arisen from the use of the guideline, the group reconvened in 2011 to review and update the clinical practice guideline designed for patients seen at the Philippine General Hospital. This article summarizes the latest revisions and recommendations.Downloads
References
PGH Working Group on Thyroid Cancer. Clinical Practice Guidelines of the Philippine General Hospital for the Management of Thyroid Nodules and Well-differentiated Thyroid Carcinoma. The National Health Science Journal. 2008; 42(1):56-67.
Nixon IJ, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. http://dx.doi.org/10.1016/j.surg.2011.08.016. Accessed November 2011.
Mazzaferri EL and Young RL. Papillary thyroid carcinoma: A 10 year follow-up report of the impact of therapy in 576 patients. Am J Med. 1981; 70:511-518.
DeGroot LJ, et al. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990; 71:414-424.
Samaan NA, et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: A retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992; 75:714-720.
Hay ID, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940 – 1999): Temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. Word J Surg. 2002; 26:879-885.
Shaha AR, et al. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997; 174:474-476.
Sanders LE and Cady B. Differentiated thyroid cancer: Reexamination of risk groups and outcome of treatment. Arch Surg. 1998; 133:419-425.
Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007; 246:375–381.
Sundram F, et al. Well-Differentiated Epithelial Thyroid Cancer Management in the Asia Pacific Region: A Report and Clinical Practice Guideline. Thyroid. November 2006; 16(5):461-469.
Racho, Veronica and Lim-Abrahan, Mary Anne. Comparison of Non-total thyroidectomy versus total thyroidectomy and radioactive iodine ablation for stage 1 and II Papillary Cancer of the Thyroid. Phil J. Internal Medicine. 1998. 36:137-142.
Nam-Goong IS, Kim HY, Gong G, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: Correlation with pathological findings. Clin Endocrinol (Oxf ). 2004; 60:21–28.
Grebe SK, Hay ID. Thyroid cancer nodal metastases: Biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996; 5:43–63.
Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994; 18:559–568.
Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003; 13:381–387.
Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid - Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003; 98:31–40.
Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: A study of 535 cases observed in a 50-year period. Surgery. 1992; 112:1139–1146; discussion 1146–1147.
Solorzano CC, Carneiro DM, Ramirez M, Lee TM, Irvin GL3rd. Surgeon-performed ultrasound in the management of thyroid malignancy. Am Surg. 2004; 70:576–580; discussion 580–582.
Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T. Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol. 1998; 29:4–10.
Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006; 141:489–494.
Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003; 134:946–954; discussion 954–955.
Cooper DS, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009; 19(11):1167-1217.
Mulcahy MM, et al. Relative Accuracy of Fine-Needle Aspiration and Frozen Section in the Diagnosis of Well-Differentiated Thyroid Cancer. The Laryngoscope. 1998; 108(4):494-496.
Huber GF, et al. Intraoperative frozen-section analysis for thyroid nodules: a step toward clarity or confusion? Arch Otolaryngol Head Neck Surg. 2007; 133(9):874-81.
Lumachi F, et al. FNA cytology and frozen section examination in patients with follicular lesions of the thyroid gland. Anticancer Res. 2009; 29(12):5255-7.
Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005; 71:731–734.
Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008; 144:1070–1077; discussion 1077–1078.
Leboulleux S, Rubino C, Baudin E, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005; 90:5723–5729.
Tissel LE, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg. 1996; 20:854-859.
Scheumann GF, et al. Prognostic significance and surgical management of locoregional lymph node metastasis in papillary thyroid cancer. World J Surg. 1994; 18:559-568.
Olson JA Jr, et al. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow up. Ann Surg. 1996; 223:472-478.
Gimm O, et al. Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg. 1998; 85:252-254.
Henry JF, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg. 1998; 383:167-169.
Cheah WK, et al. Complications of neck dissection for thyroid cancer. World J Surg. 2002; 26:1013-1016.
Pacini F, Elisei R, Capezzone M, et al. Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high- risk patients. Thyroid. 2001; 11:877–881.
Erdem E, et al. Comparision of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma. Eur J Surg Oncol. 2003; 29:747-749.
Shaha AR, et al. Completion thyroidectomy: A critical appraisal. Surgery. 1992; 112:1148-1153.
Sherman SI, et al. Prospective multicenter study of thyroid carcinoma treatment: Initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer. 1998; 83:1012-1021.
Shah MD, et al. Clinical course of thyroid carcinoma after neck dissection. Laryngoscope. 2003; 113:2102-2107.
Mazzaferri EL and Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97:418-428.
Mazzaferri EL and Jhiang SM. Differentiated thyroid cancer long-term impact of initial therapy. Trans Am Clin Climatol Assoc. 1994; 106:151-168.
Sawka AM, et al. A systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004; 89:3668-3676.
Mazzaferri EL. Thyroid remnant 131I ablation for papillary and follicular thyroid carcinoma. Thyroid. 1997; 7:265-271.
Carril JM, et al. Total body scintigraphy with thallium-201 and iodine-131 in the follow up differentiated thyroid cancer. J Nucl Med. 1997; 38:686-692.
Muratet JP, et al. Predicting the efficacy of first iodine-131 treatment in differentiated thyroid cancer. J Nucl Med. 1997; 38:1362-1368.
Park HM, et al. Detection of thyroid remnant/metastasis without stunning: An ongoing dilemma. Thyroid. 1997; 7:277-280.
Hilditch TE, et al. Self-stunning in thyroid ablation: Evidence from comparative studies of diagnostic 131I and 123I. Eur J Nucl Med Mol Imaging. 2002; 29:783-788.
Edmonds CJ, Hayes S, Kermode JC, Thompson BD. Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine. Br J Radiol. 1977; 50:799–807.
Liel Y. Preparation for radioactive iodine administration in differentiated thyroid cancer patients. Clin Endocrinol (Oxf ). 2002; 57:523–527.
Sanchez R, Espinosa-de-los-Monteros AL, Mendoza V, et al. Adequate thyroid- stimulating hormone levels after levothyroxine discontinuation in the follow-up of patients with well-differentiated thyroid carcinoma. Arch Med Res. 2002; 33:478–481.
Grigsby PW, Siegel BA, Bekker S, Clutter WE, Moley JF. Preparation of patients with thyroid cancer for 131I scintigraphy or therapy by 1–3 weeks of thyroxine discontinuation. J Nucl Med. 2004; 45:567–570.
Serhal DI, Nasrallah MP, Arafah BM. Rapid rise in serum thyrotropin concentrations after thyroidectomy or withdrawal of suppressive thyroxine therapy in preparation for radioactive iodine administration to patients with differentiated thyroid cancer. J Clin Endocrinol Metab. 2004; 89:3285–3289.
Pacini F, Ladenson PW, Schlumberger M, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: Results of an international, randomized, controlled study. J Clin Endocrinol Metab. 2006; 91:926–932.
Pilli T, Brianzoni E, Capoccetti F, et al. A comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-iodine administered doses for recombinant thyrotropin-stimulated postoperative thyroid remnant ablation in differentiated thyroid cancer. J Clin Endocrinol Metab. 2007; 92:3542–3546.
Chianelli M, Todino V, Graziano F, et al. Low dose (2.0 GBq; 54 mCi) radioiodine postsurgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low risk patients. Eur J Endocrinol. 2009; 160: 431–436.
Tuttle RM, Brokhin M, Omry G, et al. Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med. 2008; 49:764–770.
Rosario PW, et al. Efficacy of low and high 131I doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on post-operative cervical uptake. Nucl Med Commun. 2004; 25:1077-1081.
Bal C, et al. Prospective randomized clinical trial to evaluate the optimal dose of 131 I for remnant ablation in patients with differentiated thyroid carcinoma. Cancer. 1996; 77:2574-2580.
Creutzig H. High or low dose radioiodine ablation of thyroid remnants? Eur J Nucl Med. 1987; 12:500-502.
Johansen K, et al. Comparison of 1073 MBq and 3700 MBq iodine-131 in postoperative ablation of residual thyroid tissue in patients with differentiated thyroid cancer. J Nucl Med. 1991; 32:252-254.
Doi SA, et al. Ablation of the thyroid remnant and 131I dose in differentiated thyroid cancer. Clin Endocrinol (Oxf). 2000; 52:765-773.
McGriff NJ, et al. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med. 2002; 34:554-564.
Pujol P, et al. Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer. J Clin Endocrinol Metab. 1996; 81:4318-4323.
Cooper DS, et al. Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid. 1998; 8:737-744.
Surks MI, et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA. 2004; 291(2):228-238.
Tenerz A, et al. Is a more active attitude warranted in patients with subclinical thyrotoxicosis? J Intern Med. 1990; 228:229-233.
Sawin CT, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older patients. N Engl J Med. 1994; 331:1249-1252.
Wilson PC, et al. The management of advanced thyroid cancer. Clin Oncol (R Coll Radiol). 2004; 16:561-568.
Goettlieb JA, et al. Chemotherapy of thyroid cancer. An evaluation of experience with 37 patients. Cancer. 1992; 30:848-853.
Goettlieb JA, et al. Chemotherapy of thyroid cancer with adriamycin. N Engl J Med. 1974; 290:93-197.
O’Bryan RM, et al. Dose response evaluation of adriamycin in human neoplasia. Cancer. 1977; 39:1940-1948.
Pacini F, et al. Treatment of refractory thyroid cancer with adriamycin. Drugs Experimental Clin Res. 1984; 10:911-916.
Haugen BR. Management of the patient with progressive radioiodine non-responsive disease. Semin Surg Oncol. 1999; 16:34-41.
Thyroid Carcinoma Task Force. AACE/AAES Medical/Surgical guidelines for clinical practice: Management of thyroid carcinoma. Endocrine Practice. May-June 2001; 7(3): 203.
Mazzaferri, EL and Kloos, RT. Current approaches to primary therapy for papillary and fFollicular thyroid carcinoma. J Clin Endocrinol Metab. 2001; 84(4):1447.
Sherman, Steven I. Radioiodine treatment of differentiated thyroid cancer. http://www.uptodate.com. Version 13.1, last revised January 14, 2001. Accessed September 2011.
Edmonds CJ, et al. Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine. British Journal of Radiology. November 1977; 50(599):799-807.
Toubeau M, et al. Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 2004; 45:988-994.
Rouxel A, et al. Prognostic factors associated with the survival of patients developing loco-regional recurrences of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2004; 89:5362-5368.
Spencer CA, et al. Detection of residual and recurrent differentiated thyroid carcinoma by serum thyroglobulin measurement. Thyroid. 1999; 9:435-441.
Spencer CA. Challenges of serum thyroglobulin measurement in the presence of thyroglobulin autoantibodies. J Clin Endocrinol Metab 2004; 89:3702-3704.
Bachelot A, et al. Neck recurrence from thyroid carcinoma: Serum thyroglobulin and high-dose total body scan are not reliable criteria for cure after radioiodine treatment. Clin Endocrinol (Oxf). 2005; 62:376-379.
Baudin E, et al. Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients. J Clin Endocrinol Metab. 2003; 88:1107-1111.
Schaap J, et al. Does radioiodine therapy have disadvantageous effects in non-iodine accumulating differentiated thyroid carcinoma? Clin Endocrinol. 2002; 57:117-124.
Spencer CA, et al. Serum thyroglobulin antibodies: Prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 1998; 83:1121-1127.
Chiovato L, et al. Disappearance of humoral thyroid autoimmunity after complete removal of thyroid antigens. Ann Intern Med. 2003; 139:346-351.
Rubello D, Casara D, Girelli ME, Piccolo M, Busnardo B. Clinical meaning of circulating antithyroglobulin antibodies in differentiated thyroid cancer: A prospective study. J Nucl Med. 1992; 33:1478-80
Pacini F, et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003; 88:3668-3673.
Mazzaferri EL, et al. Author’s response: A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid cancer. J Clin Endocrinol Metab. 2003; 88:4508-4509.
Schlumberger M, et al. 131-I Therapy for elevated thyroglobulin levels. Thyroid. 1997; 7:273-276.
Mazzaferri EL, et al. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001; 86:1447-1463.
Pacini F, et al. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum thyroglobulin levels after initial treatment. J Clin Endocrinol Metab. 2002; 87:1499-1501.
Koh JM, et al. Effects of therapeutic doses of 131I in thyroid papillary carcinoma patients with elevated thyroglobulin level and negative 131I whole-body scan: Comparative study. Clin Endocrinol (Oxf). 2003; 58:421-427.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
