Prise en charge des cancers différenciés de la thyroïde

Treatment of differentlated thyroid cancers. Surgery is the first - and sometimes the only - treatment of differentiated thyroid cancers. The main goal is to resect all macrospcopic disease with low permanent morbidity. Total thyroidectomy is most often the recommended treatment, but in some cancers active surveillance or lobectomy can also be performed. Neck dissections are recommended in case of macroscopic lymph node metastases, but in the absence of known neck lymph node metastases, prophylactic neck dissection is controversial. Following initial surgery the administration of radioactive iodine (RAI) is not systematic due to the absence of demonstrated benefits on overall survival or on disease-free survival in most patients. Indications for RAI are based on the risk of post-operative persistent disease or relapse during further follow-up. This risk is based on the pathology of the thyroid cancer and on the results of post-operative neck ultrasonography and thyroglobulin levels. In the absence of prospective randomized studies on the utility of RAI, indications and administration modalities can vary from one center to another. Indications for RAI are discussed for each patient in multidisciplinary teams. Follow- up is based on the results of neck ultrasonography and thyroglobulin measurement performed 6 to 12 months after initial treatment. Patients are then classified into 4 categories: excellent response, indeterminate response, biochemical incomplete response, or structural incomplete response. Further management is based on the response category.