Controversies in primary treatment of low-risk papillary thyroid cancer

Donald S A McLeod, Anna M. Sawka, David S Cooper

Research output: Contribution to journalArticle

Abstract

In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.

Original languageEnglish (US)
Pages (from-to)1046-1057
Number of pages12
JournalThe Lancet
Volume381
Issue number9871
DOIs
StatePublished - Mar 2013

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Practice Guidelines
Neck Dissection
Evidence-Based Practice
Practice Management
Incidence
Thyroidectomy
Thyrotropin
Therapeutics
Disease Management
Thyroxine
Randomized Controlled Trials
Recurrence
Mortality
Papillary Thyroid cancer
Serum
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

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Controversies in primary treatment of low-risk papillary thyroid cancer. / McLeod, Donald S A; Sawka, Anna M.; Cooper, David S.

In: The Lancet, Vol. 381, No. 9871, 03.2013, p. 1046-1057.

Research output: Contribution to journalArticle

McLeod, Donald S A ; Sawka, Anna M. ; Cooper, David S. / Controversies in primary treatment of low-risk papillary thyroid cancer. In: The Lancet. 2013 ; Vol. 381, No. 9871. pp. 1046-1057.
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