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  • Review Article
  • Published:

Differentiated thyroid cancer—personalized therapies to prevent overtreatment

Nature Reviews Endocrinology volume 10, pages 563–574 (2014)Cite this article

Subjects

Key Points

  • In some patients with a very low risk of differentiated thyroid cancer or in patients with a high risk of complications, watchful waiting instead of aggressive treatment might be appropriate

  • High surgical comorbidity due to hypoparathyroidism or recurrent laryngeal nerve palsy can best be prevented by referral to an experienced thyroid surgeon

  • In patients with advanced differentiated thyroid carcinoma, dosimetry might be appropriate before 131I therapy to maximize the effect of treatment

  • Comorbidity due to hypothyroidism can be prevented by the use of recombinant human TSH before initiation of 131I therapy, diagnostic 131I scintigraphy or stimulated measurement of thyroglobulin levels

  • On the basis of individual tumour genetic characteristics, new multitargeted kinase inhibitors enable a more personalized treatment of patients who have an aggressive presentation of thyroid carcinoma

Abstract

The concept of individualized therapy is rapidly gaining recognition in the management of patients with differentiated thyroid cancer (DTC). This Review provides an overview of the most important elements of this paradigm shift in DTC management and discusses the implications for clinical practice. In the majority of patients with DTC who have an inherently good prognosis, the extent of surgery, the dosage of 131I therapy and the use of levothyroxine therapy are all aspects suitable for individualization, on the basis of both the stage of disease and the response to treatment. In individuals with advanced disease, newer imaging techniques, advances in 131I therapy and the use of targeted molecular therapies (such as multitargeted kinase inhibitors) have provided new options for the personalized care of patients, for whom until recently no effective therapies were available. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of 131I treatment, and major salivary gland damage, a common and unpleasant side effect of 131I therapy. Highly individualized interdisciplinary treatment of patients with DTC might lead to improved outcomes with reduced severity and frequency of complications and adverse effects. However, in spite of ongoing research, personalized therapies remain in their infancy.

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Figure 1: Efficacy of sorafenib in the treatment of differentiated thyroid cancer.

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Acknowledgements

The authors thank A. Pfestroff, MD, for editorial assistance.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Giessen and Marburg, Baldingerstrasse, 35033, Marburg, Germany

    Markus Luster

  2. Department of Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany

    Theresia Weber

  3. Department of Nuclear Medicine, University Hospital Aachen, Paulelsstrasse 30, Aachen, 52074, Germany

    Frederik A. Verburg

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  1. Markus Luster
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  3. Frederik A. Verburg
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M.L., T.W. and F.A.V. researched data for the article, provided substantial contributions to discussions of the content, wrote the article and reviewed and edited the manuscript before submission.

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Correspondence to Markus Luster.

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Competing interests

M.L. declares that he has acted as a consultant for AstraZeneca, Bayer Healthcare, Genzyme and Sobi, and has received speaker honoraria and research support from Genzyme, Henning and Merck. T.W. has received research support from B. Braun-Stiftung and speaker honoraria from Genzyme. F.A.V. declares that he has acted as a consultant for Roche Healthcare and has received speaker honoraria from Genzyme.

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Luster, M., Weber, T. & Verburg, F. Differentiated thyroid cancer—personalized therapies to prevent overtreatment. Nat Rev Endocrinol 10, 563–574 (2014). https://doi.org/10.1038/nrendo.2014.100

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