1st June 2007
Association of Comprehensive Cancer Centres - Disease Specific Society
Summary,


GUIDELINE OBJECTIVE(S)

To improve the following aspects regarding the care of patients with differentiated thyroid carcinoma:

• Diagnosis, referral, and treatment
• Overall and disease-free survival
• Quality of life

TARGET POPULATION

Children and adults with differentiated (nonmedullary) thyroid carcinoma

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis/Evaluation/Follow-up

1. Patient history
2. Physical examination
3. Laboratory tests (calcitonin thyroid stimulating hormone [TSH] radioiodine [131I] uptake assays; thyroglobulin [Tg] and anti-Tg antibodies levels; Tg messenger ribonucleic acid [mRNA - not recommended])
4. Imaging (scintigraphy [not recommended for primary diagnosis], ultrasound, computed tomography [CT], magnetic resonance imaging [MRI])
5. Cytology (fine needle aspiration cytology [FNAC], ultrasound-guided or palpation-guided cytological biopsy)
6. Perioperative frozen section assessment (not recommended for diagnosis of thyroid tumours)
7. No further investigation for incidentally found impalpable thyroid nodules

Management/Treatment

1. Surgery (hemithyroidectomy, total thyroidectomy plus 131I ablation)
2. Radioablation (preablation scintigram with 123I or 131I, ablation dose, preablation recombinant human TSH (rhTSH), iodine restriction diet prior to 131I ablation, scintigraphy, or therapy
3. Management after initial therapy
   • Vocal cord assessment
   • Management of vocal cord paralysis (tracheotomy, logopaedia)
   • Peri- and postoperative care of parathyroid glands
   • Adjuvant treatment (external radiotherapy or TSH suppression following radioablation)
4. Treatment of local recurrence (locoregional surgery or radiotherapy)
5. Treatment of distant metastases (surgery, radiotherapy)
6. Other treatment options (radiofrequency ablation, bisphosphonates, embolization, chemotherapy, fixed-dose administration of 131I, rhTSH during 131I therapy

Special Considerations

1. Diagnosis and treatment of pregnant patients with thyroid carcinoma
2. Treatment of pediatric patients with thyroid carcinoma
3. Organization of care
4. Supportive care

MAJOR OUTCOMES CONSIDERED

• Overall and disease-free survival rates
• Rate of local recurrence
• Rate of distant metastases
• Quality of life
• Sensitivity and specificity of diagnostic methods