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Endocrinology and Metabolism Clinics of North America

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https://read.qxmd.com/read/30717915/entering-an-era-of-precision-management-of-thyroid-cancer
#1
EDITORIAL
Mingzhao Xing
No abstract text is available yet for this article.
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717914/thyroid-cancer
#2
EDITORIAL
Adriana G Ioachimescu
No abstract text is available yet for this article.
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717913/clinical-assessment-and-risk-stratification-in-differentiated-thyroid-cancer
#3
REVIEW
Fernanda Vaisman, R Michael Tuttle
Thyroid cancer management is rapidly evolving to a personalized management approach. Risk stratification systems are designed to assist in personalized management. Differentiating patients who may benefit from aggressive therapy and intense follow-up as opposed to those who can be successfully treated with minimalized initial management options and follow-up is crucial to the development of the right treatment plan for the right patient in order to optimize initial therapy and follow-up testing. This article aims to describe and discuss the risk stratification systems currently recommended for differentiated thyroid cancer...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717912/molecular-diagnostic-evaluation-of-thyroid-nodules
#4
REVIEW
Sarah E Mayson, Bryan R Haugen
The historical management approach for many patients with indeterminate thyroid nodule fine needle aspiration cytology is a diagnostic lobectomy or thyroidectomy. However, the majority of patients undergo surgery unnecessarily, because most are proven to have benign disease on histology. Molecular testing is a diagnostic tool that can be used to help guide the clinical management of thyroid nodules with indeterminate cytology results. Testing has evolved substantially over the last decade with significant advances in testing methodology and improvements in our understanding of the genetic basis of thyroid cancer...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717911/clinical-diagnostic-evaluation-of-thyroid-nodules
#5
REVIEW
Carolyn Maxwell, Jennifer A Sipos
The presence of a thyroid nodule may be recognized by the patient or the clinician on palpation of the neck or it may be an incidental finding during an imaging study for some other indication. The method of detection is less important, however, than distinguishing benign lesions from more aggressive neoplasms. This article outlines the diagnostic algorithm for the evaluation of thyroid nodules including biochemical testing, imaging, and, when appropriate, fine-needle aspiration. In addition, the authors review the natural history of benign nodules, follow-up strategies, and indications for repeat aspiration...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717910/coding-molecular-determinants-of-thyroid-cancer-development-and-progression
#6
REVIEW
Veronica Valvo, Carmelo Nucera
Thyroid cancer is the most common endocrine malignancy. Its incidence and mortality rates have increased for patients with advanced-stage papillary thyroid cancer. The characterization of the molecular pathways essential in thyroid cancer initiation and progression has made huge progress, underlining the role of intracellular signaling to promote clonal evolution, dedifferentiation, metastasis, and drug resistance. The discovery of genetic alterations that include mutations (BRAF, hTERT), translocations, deletions (eg, 9p), and copy-number gain (eg, 1q) has provided new biological insights with clinical applications...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717909/management-of-medullary-thyroid-cancer
#7
REVIEW
David Viola, Rossella Elisei
Medullary thyroid cancer (MTC) is rare but aggressive. It can be cured only if intrathyroid at diagnosis. MTC can be sporadic (75%) or familial (25%) and the 2 forms are distinguished by RET mutations analysis. Calcitonin is the specific serum marker; its doubling time is the most important prognostic factor for survival and progression; 30% of MTC patients have distant metastases at diagnosis and, when progressing, systemic therapy with vandetanib or cabozantinib should be considered. Before starting this treatment, the possibility of using a local treatment should be evaluated to delay systemic therapy...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717908/diagnosis-and-management-of-anaplastic-thyroid-cancer
#8
REVIEW
Ashish V Chintakuntlawar, Robert L Foote, Jan L Kasperbauer, Keith C Bible
Anaplastic thyroid cancer (ATC) is a devastating and usually incurable diagnosis. Clinical and pathologic diagnosis is best assessed at a tertiary center with concentrated ATC expertise. Expeditious multidisciplinary management is recommended for optimal patient outcomes. Based on multiinstitutional and population-based studies, multimodal therapy that includes chemoradiotherapy with surgery (when feasible) is the preferred initial treatment because it is associated with incrementally improved overall survival...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717907/novel-drug-treatments-of-progressive-radioiodine-refractory-differentiated-thyroid-cancer
#9
REVIEW
Steven P Weitzman, Steven I Sherman
Systemic therapy options have emerged for treatment of progressive, radioiodine-refractory differentiated thyroid carcinoma. Approved therapies that target tumor angiogenesis, lenvatinib and sorafenib, improve progression-free survival and, in an older subset, lenvatinib can prolong overall survival. Treatments based on targeting specific somatic genetic alterations are also available, which potentially also may prolong progression-free survival but are not yet approved for use by the Food and Drug Administration for this specific disease...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717906/surveillance-for-differentiated-thyroid-cancer-recurrence
#10
REVIEW
Prasanna Santhanam, Paul W Ladenson
Serum thyroglobulin monitoring along with anatomic and functional imaging play key roles in the surveillance of patients with differentiated thyroid cancer after initial treatment. Among patients with a disease stage justifying thyroid remnant ablation or with suspected metastatic disease, radioiodine whole-body scans are essential in the months after surgery. For patients with low to moderate-risk cancers, ultrasonography of the neck (with measurement of serum thyroglobulin on thyroid hormone replacement) are the best initial diagnostic modalities, and are often the only tests required...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717905/evolving-understanding-of-the-epidemiology-of-thyroid-cancer
#11
REVIEW
Carolyn Dacey Seib, Julie Ann Sosa
The incidence of thyroid cancer worldwide has increased significantly over the past 3 decades, due predominantly to an increase in papillary thyroid cancer. Although most of these cancers are small and localized, population-based studies have documented a significant increase in thyroid cancers of all sizes and stages, in addition to incidence-based mortality for papillary thyroid cancer. This suggests that the increasing incidence of thyroid cancer is due in large part to increasing surveillance and overdiagnosis, but that there also appears to be a true increase in new cases of thyroid cancer...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717904/thyroid-hormone-suppression-therapy
#12
REVIEW
Bernadette Biondi, David S Cooper
Thyroid hormone suppression therapy is designed to lower serum thyrotropin (TSH) levels using doses of thyroid hormone in excess of what would normally be required to maintain a euthyroid state. The basis of this therapy is the knowledge that TSH is a growth factor for thyroid cancer, so that lower serum TSH levels might be associated with decreased disease activity. However, clinical studies have not documented improved outcomes with TSH suppression, except in patients with the most advanced disease. Furthermore, there are a number of negative outcomes related to aggressive thyroid hormone therapy, including osteoporosis, fracture, and cardiovascular disease...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717903/conservative-surveillance-management-of-low-risk-papillary-thyroid-microcarcinoma
#13
REVIEW
Akira Miyauchi, Yasuhiro Ito
Most low-risk papillary thyroid microcarcinomas are indolent. Ten years of active surveillance at Kuma Hospital revealed that only 8.0% of patients showed enlargement of 3 mm or greater, whereas only 3.8% showed nodal metastasis. None, including those who underwent rescue surgery after the detection of progression, showed life-threatening recurrence or distant metastasis, and none died of thyroid carcinoma. Adverse events were significantly more frequent in patients who underwent immediate surgery than in those who had active surveillance...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717902/management-of-papillary-thyroid-microcarcinoma
#14
REVIEW
Juan P Brito, Ian D Hay
The worldwide incidence of thyroid cancer is increasing. A third of new thyroid cancer cases are papillary thyroid microcarcinoma (PTM), which are 1 cm or less. These tumors are mostly indolent with excellent prognosis. Although thyroid surgery is the most common management option for patients with PTM, new management options demand that treatment decisions must be individualized and based on patient's preference, context, and biology. This article describes management options for PTM patients and shared decision-making as a novel method for individualizing care...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717901/conventional-radioiodine-therapy-for-differentiated-thyroid-cancer
#15
REVIEW
Dorina Ylli, Douglas Van Nostrand, Leonard Wartofsky
This article presents an overview of the use of radioactive iodine (131-I) in the treatment of patients with differentiated thyroid cancer. Topics reviewed include definitions; staging; the 2 principal methods for selection of 131-I dosage; the indications for ablation, adjuvant treatment, and treatment; the recommendations for the use of 131-I contained in the guidelines of the American Thyroid Association and the Society of Nuclear Medicine and Molecular Imaging; the dosage recommendations and selection of dosage approach for 131-I by these organizations; the use of recombinant human thyrotropin for radioiodine ablation, adjuvant therapy, or treatment; and the MedStar Washington Hospital Center approach...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717900/transoral-endoscopic-thyroidectomy-for-thyroid-cancer
#16
REVIEW
Isariya Jongekkasit, Pornpeera Jitpratoom, Thanyawat Sasanakietkul, Angkoon Anuwong
The prevalence of low-risk differentiated thyroid cancer (DTC) is dramatically increasing because of superior diagnostic imaging technologies. Remote-access endoscopic thyroidectomy is becoming more popular for the lack of a noticeable neck scar. Transoral endoscopic thyroidectomy, vestibular approach (TOETVA) is the only technique that could be called a true scarless surgery; however, there is a scarcity of long-term studies about its safety and feasibility. Because thyroid cancer is a slow-growing lesion, with adequate follow-up and surveillance, TOETVA is a surgical procedure for the management of low-risk DTC without any difference of surgical and oncological outcome...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717899/conventional-robotic-endoscopic-thyroidectomy-for-thyroid-cancer
#17
REVIEW
Meghan E Garstka, Ehab S Alameer, Saad Al Awwad, Emad Kandil
The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic thyroidectomies in the United States and are responsible for recent increases in utilization patterns despite higher complication rates. These trends highlight the importance of increasing surgeon exposure to and experience with these techniques in order to improve procedure safety...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717898/neck-dissection-in-the-surgical-treatment-of-thyroid-cancer
#18
REVIEW
Ahmad M Eltelety, David J Terris
The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid cancer remains the most common thyroid malignancy. It has a high tendency for regional metastasis to the cervical lymph nodes. The optimal management of the neck in patients with thyroid carcinoma has long been an important topic of debate. This article addresses central and lateral neck dissection, providing a simplified guide to the most up-to-date and evidence-based practices...
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717897/conventional-thyroidectomy-in-the-treatment-of-primary-thyroid-cancer
#19
REVIEW
Benjamin R Roman, Gregory W Randolph, Dipti Kamani
This article focuses on conventional surgical management of thyroid cancer, reviewing long-standing and well-accepted main principles and practices. It also covers newer controversies and techniques to conventional thyroidectomy, including changes in the indications for thyroidectomy, the intraoperative management of the recurrent and superior laryngeal nerves and parathyroid glands, the extent of thyroidectomy, and the importance of outcomes measurement and quality improvement.
March 2019: Endocrinology and Metabolism Clinics of North America
https://read.qxmd.com/read/30717896/genetic-guided-risk-assessment-and-management-of-thyroid-cancer
#20
REVIEW
Mingzhao Xing
Controversies exist on how to optimally manage thyroid cancer because the prognosis is often uncertain based on clinical backgrounds. This can now be helped with prognostic genetic markers in thyroid cancer, exemplified by BRAF V600E and TERT promoter mutations, which have been well characterized and widely appreciated. The genetic duet of BRAF V600E/RAS and TERT promoter mutations is a most robust prognostic genetic pattern for poor prognosis of differentiated thyroid cancer. The high negative predictive values of the prognostic genetic markers are equally valuable...
March 2019: Endocrinology and Metabolism Clinics of North America
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