The SELECT Trial and Differentiated Thyroid Cancer - Episode 2

Treatment Options for Patients With Differentiated Thyroid Cancer

Lori Wirth, MD, discusses treatment options and potential adverse effects for differentiated thyroid cancer.

Lori Wirth, MD: Do all patients require immediate treatment for a DTC [differentiated thyroid cancer]? The answer is becoming no more and more commonly. We’re learning that less is more in the good actors in terms of DTCs. If a diagnosis is made but the nodule is small, 1.5 cm or smaller, on FNA [fine needle aspiration] it’s a typical papillary thyroid carcinoma, and there are no suspicious lymph nodes or other high-risk features in terms of what’s being seen by imaging. Many patients can be safely followed and undergo treatment only if there is growth of that small thyroid nodule. If there is growth, then there probably is an indication for treatment, which would typically first involve surgery. There are downsides to doing surgery and risks involved. The risks are uncommon, but you can see hypoparathyroidism and vocal cord paralysis as risks to thyroid surgery. In a patient who has a small nodule that’s not growing, they may be able to be safely observed over time.

When patients do have a thyroid cancer diagnosed in the thyroid gland by FNA, the lesion is larger than 1.5 cm. There are other reasons not to follow that patient by active surveillance, like when surgery is typically done. There are different operative approaches. In some cases, if there are no high-risk features, a hemithyroidectomy may be appropriate. However, some patients will need a total thyroidectomy and lymph node dissections based on the presentation. If it’s suspected that the patient will have intermediate- or high-risk disease, those patients should have a total thyroidectomy plus the appropriate nodal dissection, which will then facilitate treatment with postoperative radioactive iodine.

Transcript edited for clarity.