Current controversies in thyroid cancer

Thyroid cancer is the most common endocrine cancer and the eighth most common cancer diagnosed each year. Patients with risk factors for thyroid cancer or thyroid nodules warrant further work-up consisting of cervical neck ultrasound and possible fine-needle aspiration biopsy. Patients with biopsy-proven well-differentiated cancer undergo total thyroidectomy. Those patients with indeterminate nodules may proceed with further work-up consisting of molecular testing or surgical biopsy. Patients noted to have locally advanced disease to regional lymph nodes on preoperative imaging warrant compartment-oriented lymphadenectomy. The decision to perform prophylactic central neck dissection is controversial and may be associated with increased perioperative morbidity. Radioactive iodine ablation may be considered in the postoperative setting for patients with high-risk tumor factors. It may also be used for recurrent or metastatic disease not amenable to surgical resection. Similarly, therapy for unresectable and metastatic disease consists of chemotherapeutic agents targeted toward known genetic mutations associated with thyroid cancer.