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Endocrine Oncology Thyroid Carcinoma Current and Future Perspectives in Thyroid Carcinoma Treatment José Manuel Gómez-Sáez Chief Clinician, Endocrinology and Nutrition Service, Bellvitge University Hospital, Barcelona and Professor, University of Barcelona, Barcelona, Spain. Abstract Thyroid nodules are a common clinical problem and evaluation with neck and thyroid ultrasound and fine-needle aspiration biopsy are the most accurate methods for evaluating and identifying those that require surgical resection. The surgical treatment of differentiated thyroid carcinoma is the most common and recommended approach. Post-operative 131 I remnant ablation is used to eliminate the post-surgical thyroid remnant and may facilitate the early detection of recurrence. The conclusion of two important recent studies is that the use of recombinant human thyrotropin and low 131 I dose, 30 mCi, for post-operative ablation may be sufficient for the management of low-risk thyroid cancer. Recently, multi-targeted kinase inhibitors have emerged as promising treatments for metastatic differentiated thyroid cancers based on mutation detection in samples from thyroid cancer. Motesanib, sorafenib, vandetanib, sunitinib, lenvatinib, imatinib and cabozantinib are multi-kinase inhibitors that have the ability of inhibiting the rearranged during transection (RET) and vascular endothelial growth factor receptor (VEGFR), and other kinases, and have been used in advanced differentiated thyroid carcinoma. By contrast, axitinib and pazopanib seem to act only as anti-angiogenic agents. Anaplastic thyroid carcinoma is often advanced and metastatic at diagnosis. Patients with localised disease not amenable to surgical resection can be treated with adjuvant chemoradiotherapy. Keywords Thyroid nodules, differentiated thyroid carcinoma, anaplastic thyroid carcinoma, thyroid surgery, radioiodine, motesanib, sorafenib, vandetanib, sunitinib, lenvatinib, imatinib, cabozantinib Disclosure: The author has no conflicts of interest to declare. Received: 7 January 2013 Accepted: 30 January 2013 Citation: European Endocrinology, 2013;9(1):22–7 Correspondence: José Manuel Gómez-Sáez, c/Sabino de Arana 40,3º,2ª 08028 Barcelona, Spain. E: jmgs@bellvitgehospital.cat Thyroid nodules are a common clinical problem and with the growing use of diagnostic imaging, the number of thyroid nodules identified and undergoing further diagnostic evaluation by fine-needle aspiration biopsy (FNA) is steadily growing. Only 5  % of all thyroid nodules harbour malignancy and thyroid cancer constitutes only 1  % of all epithelial malignancies worldwide and represents 95 % of all endocrine malignancies. Thyroid cancer incidence has more than doubled in the past decade, with an associated rise in mortality. 1,2 It is currently unknown whether the increase in papillary thyroid cancer (PTC) is real or is an artefact of improved diagnostic techniques and other procedures, or of increased screening for small nodules. Differentiated thyroid carcinoma (DTC), which includes PTC, follicular and poorly differentiated carcinomas, accounts for approximately 95  % of all thyroid cancer cases 1 and most patients with DTC have an excellent prognosis; 3,4 however, recurrence is observed in 10–15  % of patients following surgery. 1 Following the spirit of concrete cultural and scientific integration among the countries participating in the new reality of the EU, the European Thyroid Association and also the American Thyroid Association have endorsed the implementation of a consensus and guidelines for the management of thyroid nodules and thyroid cancer. 5,6 Medullary thyroid cancer (MTC) is a malignancy of the parafollicular C cells of the thyroid and accounts for up to 5  % of all thyroid cancer cases, but causes a disproportionate number of thyroid cancer-related deaths. MTC occurs in both sporadic and hereditary settings, the latter accounting for approximately 25 % of MTC cases. The hereditary form of MTC occurs as a component of the autosomal, dominantly inherited 22 cancer syndromes, multiple endocrine neoplasia type 2A, multiple endocrine neoplasia type 2B and familial MTC and is the most common cause of death in patients with these syndromes. 7 Anaplastic thyroid carcinoma (ATC) is by far the most deadly of thyroid- derived tumours, but fortunately accounts for but a small percentage. In the US, ATC is responsible for 1.7  % of all thyroid cancers, while geographically the prevalence ranges from 1.3 to 9.8  %. In several countries, the prevalence of ATC has decreased dramatically, due in part to increased dietary iodine and better management of DTC. 8 Recently, the American Thyroid Association endorsed a guideline for management of patients with recommendations for patients with ATC. 8 While all thyroid cancer patients require a multi-disciplinary team of specialists for optimal care, the coordinating physician is frequently an endocrinologist who has established a long-standing relationship with the patient who has DTC or MTC. By contrast, the sudden onset and explosive course of ATC necessitates immediate involvement by surgeons, radiation and medical oncologists and palliative care teams. Diagnostic Approach to and Treatment of Thyroid Nodules Thyroid nodules are the clinical manifestation of a wide spectrum of thyroid diseases. In a normal gland or a diffuse goiter, thyroid nodules may be solitary or multiple. Among multi-nodular goiters, one nodule may become clinically dominant in terms of growth, dimension and functional characteristic. The aim of the diagnostic approach to thyroid nodules is a differential diagnosis between benign and malignant nodules and, in the event of malignancy, the selection of an appropriate surgical procedure. 5–7 © Tou c h ME d ica l ME d ia 2013