English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Since the landmark paper by Mazzaferri and Jhiang (1) indicating the benefit of adequate surgery and postoperative radioactive iodine treatment in patients with well-differentiated thyroid cancer (DTC), a lot has been learned about prognostic factors associated with disease recurrence and mortality and the risks and benefits of treatment. In addition, over the past 3 decades we have experienced a dramatic improvement in imaging and laboratorial techniques resulting in highly sensitive and specific studies for disease detection, and have observed a significant advance in the understanding of the molecular pathogenesis of thyroid cancer. This accumulated knowledge has confirmed a few paradigms and has provided im portant insights that have refined the treatment of thyroid cancer. First, surgery is the mainstay treatment of thyroid cancer and therefore an experienced surgeon and an adequate surgical treatment have the highest impact in cure. Second, the major roles and best responses of radioactive iodine treatment are in reducing recurrence rate in high-risk patients and in treating young patients with micronodular lung metastases and; third, the development of kinase inhibitors has been a major breakthrough in treating metastatic thyroid cancer, not only DTC but also medullary thyroid cancer (MTC). In this issue of Archives of Endocrinology and Metabolism three papers describe different facets of thyroid cancer treatment. On one side of the spectrum, Furtado and cols. demonstrate the low incidence of persistent (3.5%) and recurrent disease (2.5%) in patients with papillary thyroid cancer with less than 5 lymph nodes detected only at the operative procedure and without other poor prognostic factors (2). As expected, these patients have low risk of recurrence raising the question whether radioactive iodine treatment provides any benefit, a situation in which the disease could be less harmful than the treatment. Interestingly, in the 2009 American Thyroid Association guidelines, all patients with lymph node (LN) metastases (N1 disease), regardless of number and size of LN, were considered intermediate risk and adjuvant radioactive iodine treatment was recommended (3). However, data have accumulated demons trating that the risk of recurrence is significantly lower in patients with small LNs de tected pathologically when compared to pre-operatively detected lymph nodes (4-6), findings confirmed in the study by Furtado and cols. On the other side of the spectrum, two papers describe the “good and bad” of tyrosine kinase inhibitors. In one paper, Pitoia and cols. report a patient with advanced MTC and ectopic Cushing’s syndrome in whom treatment with vandetanib resulted in rapid resolution of hypercortisolism (7). Ectopic ACTH syndrome is rarely obser ved in MTC but is usually associated with extensive disease and significant symptoms. The control of cortisol hypersecretion results in symptomatic relief and better quality of life. This is an important observation that has been also demonstrated with sorafenib and sunitinib and expands the known effects of kinase inihibitors. In a second

The evolving field of thyroid cancer: refinement of old and creation of new paradigms