Treatment of Papillary Thyroid Cancer at High Estimated Risk of Recurrence

In papillary thyroid carcinoma, specific pathological findings indicate a high estimated risk of recurrence and call for a more intensive treatment approach guided by established clinical practice guidelines.

Clinical Scenario

This protocol addresses papillary thyroid carcinoma at high estimated risk of recurrence, defined by the presence of at least one of the following: gross extrathyroidal extension, pathological nodal metastasis measuring greater than 3 cm, extranodal extension, incomplete tumour resection, or distant metastases.

Treatment Approach

The standard approach involves total thyroidectomy followed by high-activity radioactive iodine therapy. Preparation is carried out using either levothyroxine withdrawal or recombinant human TSH (rhTSH). The specific activity levels, sequencing, and full decision algorithm are detailed in the complete protocol.

Full regimen, activity thresholds, and clinical decision algorithm available in the protocol.

Treatment Goals

An excellent response is defined as negative imaging, undetectable anti-thyroglobulin antibodies, and serum thyroglobulin below a defined threshold (with specific numeric targets in the protocol), assessed 6–18 months after treatment.

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References

DOI: 10.1093/annonc/mdz400

practice guidelines unanimously recommend treatment with high RAI activities (100 mCi, 3.7 GBq) for patients with high risk of recurrence.
For other TCs, total thyroidectomy is still considered the standard surgical treatment.
Treatment with high RAI activities (100 mCi, 3.7 GBq; rhTSH administration or levothyroxine withdrawal) is recommended for patients at high risks of recurrence.
All patients with DTC should have neck US and serum Tg and TgAb assays 6–18 months after primary treatment.

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