Management of Differentiated Thyroid Carcinoma (DTC): An Update

Dear Colleagues,

Differentiated thyroid carcinomas (DTC) are the most prevalent endocrine malignant tumours; DTC incidence has increased worldwide over the last decades as a consequence of diagnostic accuracy, while DTC-related mortality has remained unchanged.

The management of DTC patients should be individualized according to the initial and ongoing risk stratification, and tailored according to individual needs and preferences.

Ultrasonography followed by FNA with cytological examination are the most important diagnostic tools (see TIRADS and Bethesda classification). However other patients’ related features (genetic syndrome, radiation exposure) contribute to defining the tumour behaviour. Altogether, the sonographic features of the thyroid nodule; Bethesda categories; molecular testing; and patient co-morbility (and preferences) should guide the clinician in choosing the treatment.

Recently, scientists have studied how machine learning (ML) models and big data analysis can summarise all these features stratifying the risk and support clinicians to refine diagnostic tools and improve their accuracy, resulting in a more tailored treatment (not necessarily surgical) and the performance of precision medicine.

Surgical approaches include less extensive treatments in patients with low-risk DTC (lobectomy, or minimally invasive techniques such as thermal or radiofrequency ablation) in order to reduce complications. Considering active surveillance in patients who refuse surgery could be an option.

To improve cosmetic results and avoid worsening patients’ quality of life, many authors suggest a variety of surgical procedures, including endoscopic or robotic-assisted procedures (trans-axillary approach, trans-breast approach, trans-anterior chest wall approach, retroauricular approach or the trans-oral thyroidectomy).

Intermediate and high-risk DTCs require total thyroidectomy followed by radio-active iodine (RAI) administration. There is no consensus about node management (preventive neck dissection, recurrent neck dissection).

Some kinase inhibitors such as lenvatinib and sorafenib prolong progression-free survival in patients with advanced progressive DTC and RAI refractory.

In this Special Issue we are looking for original research papers and reviews focusing on the personalized management of DTC patients. 

Prof. Dr. Massimiliano Garzaro
Prof. Paolo Aluffi Valletti
Dr. Valeria Dell’Era
Guest Editors

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• differentiated thyroid cancer (DTC)
• quality of life
• voice disorders
• machine learning
• new therapy
• surgical approaches
• surgical complications
• radioactive iodine (RAI)
• advanced local/recurrency in DTC
• neck dissection
• nerve monitoring