Thyroid tumors: the new intervention criteria on diagnosis, surgery and therapy

“Thyroid tumors are diagnosed with growing frequency all over the world: Italy records about 15.000 per year especially in the female population for which it is the fourth most frequent malignant tumor and comes to be the second in women under the age of 50, he explains Enrico Papini, Scientific manager Ame, Endocrinologists Medici Association and Director of complex Endocrinology and Metabolism diseases, Regina Apostolorum Hospital, Albano Laziale. Thanks to the improvement of the diagnostic capabilities offered by the thyroid ultrasound and by the ultrasound eagastic guidance of thyroid nodules, today thyroid neoplasms are identified when they are not yet palpable or symptomatic. This, if on the one hand it represents an important step forward in prevention, puts on the other the doubt whether it is appropriate to submit “low risk” patients with limited tumors, to the same treatment traditionally reserved for more advanced neoplasms, exposing patients to possible complications and side effects probably not indispensable “.

The news on diagnosis, surgery and therapy of thyroid cancer are discussed at the workshop “4^ Thyroid Uptodate 2016 – Guidelines vs Clinical Practice: Consens and disputes“Promoted by Ame, Endocrinologi Medici Association, and by the Regina Apostolorum hospital in Albano Laziale, with the unconditional contribution of Ibsa Pharmaceuticals, which takes place in Ariccia on 7 and 8 October p.v. (link to the program).

“90-95% of thyroid nodules are benign, continue Paolo Vitti, President elected Sie, Italian Society of Endocrinology and Endocrinology Director I, Pisan University Hospital-University, And it is possible to identify the evil ones with a simple examination on cells taken from the lump with a common thin needle, the now well -known thyroid needleaspirate. This technique is highly reliable but unfortunately it is not perfect: in about 20% of cases for different reasons, insufficient aspirated biological material or for difficulties in classifying the nodules, you cannot make a certain diagnosis. The dream, already realized for other tumors, is to be able to have an objective method not based on the opinion of an examiner and the molecular examination, through the identification of genes changed in malignant cells, represents a very promising research line of research even if they have not yet found truly specific genes for thyroid tumors.

On the basis of these considerations, in the last international guidelines, the molecular examination, despite being certainly the future, is now considered only to support the diagnosis in specialized centers and, also considering the costs, not the only test to establish whether the patient should be operated or not “.

“The latest and most authoritative guidelines on the thyroid tumor of the American Thyroid Association in 2016 and the British Thyroid Association in 2014, he says Rocco Bellantone, Endocrine and metabolic surgery director of the Polyclinic “a. Gemini ”of Rome, They propose for the “microcarcinomas”, small and circumscribed tumors, a less aggressive approach than the traditional one. On the surgical level, the intervention of choice should be the removal of only half of the thyroid that contains the microcarcinoma and the intervention with a mininvasive video-assistant thyroidectomy technique (Mivat) which allows you to operate with an incision of only 2 cm.”.

“In the surgical follow-up, Papini continues the traditional therapy with radioactive iodine at high doses should be avoided in” low risk “patients or low-dose employee since the advantage in terms of survival appears very modest, in the face of an irradiation and of side effects not entirely negligible.

A more conservative surgery allows a very different approach to levotiroxine therapy, because the advantage that the residual part of the thyroid can not carry out in the maintenance of normal thyroid hormones should not be underestimated. Recent contributions in the field of pharmacology offer a portfolio of therapeutic solutions, such as the thyroid hormone in liquid solution, which can be taken together with breakfast, or in soft capsules, which can guarantee optimal absorption of the active ingredient and better adherence of the patient thanks to the ease of hiring.

Today, in summary, the treatment of thyroid cancer must be “made to measure” in relation to the different types of cancer and patient, treating aggressive neoplasms vigorously and managing more cautiously the initial ones and with favorable prognosis according to the idea that in some cases “Doing less is to do better” concludes the expert.