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Minerva Endocrinologica 2020 Jul 03

DOI: 10.23736/S0391-1977.20.03240-X


language: English

Management and follow-up of differentiated thyroid cancer not submitted to radioiodine treatment: a systematic review

Carla GAMBALE, Rossella ELISEI, Antonio MATRONE

Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy


INTRODUCTION: The treatment of differentiated thyroid cancer (DTC) has been changing. In low (LR) and intermediate (IR) risk DTC, surgery is becoming more conservative and the usefulness of radioiodine (131I) has been questioned. An increasing number of patients are treated with lobectomy or total thyroidectomy (TTx), but without 131I. Consequently, the management and the follow-up of these patients need to be revised.
EVIDENCE ACQUISITION: We reviewed the available data about the management of these growing categories of patients. We focused on the emerging roles of the conventional tools in the follow-up [thyroglobulin (Tg), thyroglobulin antibodies (TgAb) and neck ultrasound (US)]. Moreover, we evaluated the changes in the use of levothyroxine (L-T4) therapy, and the role of the ongoing risk re-stratification.
EVIDENCE SYNTHESIS: Tg, TgAb and neck US continue to represent the cornerstone of the follow-up, however, a change in their interpretation is needed. In particular, the absolute value of Tg and TgAb lost their clinical meaning, while their trend over time acquired a greater value. At variance, the diagnostic role of neck US is becoming very relevant for the early identification of the local recurrences. In addition, L-T4 therapy should be personalized according with the type of surgery, the age of patients and their co-morbidities.
CONCLUSIONS: Management of DTC treated with lobectomy or TTx but without 131I is worldwide changing. The evidences suggest that in this setting of patients with LR or IR of recurrences, a relaxed surveillance could represent the most reasonable choice.

KEY WORDS: Differentiated thyroid cancer; Low and intermediate risk; Lobectomy; Total thyroidectomy; Not ablated

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