Journal List > J Korean Thyroid Assoc > v.7(1) > 1056566

J Korean Thyroid Assoc. 2014 May;7(1):40-47. Korean.
Published online May 30, 2014.  https://doi.org/10.11106/jkta.2014.7.1.40
Copyright © 2014. the Korean Thyroid Association. All rights reserved.
Management of Recurrent Differentiated Thyroid Carcinoma
Won Bae Kim1,2
1Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Asan Medical Center, Seoul, Korea.

Correspondence: Won Bae Kim, MD, Department of Internal Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-3010-3913, Fax: 82-2-3010-6962, Email: kimwb@amc.seoul.kr
Received April 29, 2013; Revised July 09, 2013; Accepted July 23, 2013.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Patients with well differentiated thyroid carcinoma (WDTC) generally have good prognosis with appropriate therapy, but those with recurrences have higher disease specific mortality and poor quality of life requiring clinical attention. Recurrences occur in 5-20% as loco-regional form and as distant metastasis in 10-20% in long-term follow-up after initial therapy. Soft tissue recurrences as a form of local recurrence require aggressive therapy including wide excision and postoperative adjuvant therapy as they have dismal prognosis. There are controversies in proper management of loco-regional recurrences in neck lymph node, because improvement in clinical outcome of those patients through randomized, prospective study had never been documented and because it is not clear if lymph node recurrences could be a focus of further metastasis of cancer cells. Management includes surgery (compartment-oriented lymph node dissection), alcohol injection or radiofrequency ablation and simple observation. Adjuvant radioiodine therapy is not useful after re-operation, especially high dose radioiodine had been done as initial therapy. Recurrences as distant metastasis require thorough evaluation and proper management according to site and progression of each lesion. Palliative surgery if critical structure is endangered, radioiodine therapy in "radioactive iodine (RAI)-avid" lesions, external beam radiation therapy or IV bisphosphonate, embolization should be considered in bone metastasis according to clinical setting. RAI-avid lung metastasis can be managed with radioiodine, but there is no available therapeutic modality in "non-RAI-avid" lung metastatic lesions. Clinical trials using new targeted agents can be considered in those patients. There had been many trials to enhance/restore iodine uptake in metastatic lesions, but there is no clinically available agent yet. Further studies are required for development of agents to restore/enhance iodine uptake to improve efficacy of RAI therapy.

Keywords: Thyroid carcinoma; Recurrence; Metastasis; Management

Figures


Fig. 1
Management of patients with recurrent well differentiated thyroid carcinoma.
Click for larger image

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