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Journal of Thyroid Research
Volume 2012, Article ID 512401, 8 pages
http://dx.doi.org/10.1155/2012/512401
Review Article

Controversies in the Management and Followup of Differentiated Thyroid Cancer: Beyond the Guidelines

Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, 3 Dag Hammarskjold Plaza, New York, NY 10017, USA

Received 31 October 2012; Accepted 12 December 2012

Academic Editor: Maria Grazia Chiofalo

Copyright © 2012 Hala Ahmadieh and Sami T. Azar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.