REVIEW   

Minerva Endocrinologica 2020 December;45(4):306-17

DOI: 10.23736/S0391-1977.20.03240-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

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 comorbidities.
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: Thyroid neoplasms; Thyroidectomy; Risk