A 73-year-old man with prostate cancer and hypertension came to see me for an incidental diagnosis of papillary thyroid microcarcinoma (PTMC). He had undergone fluorodeoxyglucose (FDG) PET with his oncology team because of a rising serum prostate-specific antigen (PSA) level. There were no concerning findings from the prostate cancer perspective, and the PSA level subsequently declined. However, a small FDG-avid thyroid nodule was incidentally discovered.
Ultrasound revealed a 7-mm highly suspicious thyroid nodule with no extrathyroidal extension and no suspicious lymph nodes. Cytology from a fine-needle biopsy of the lesion confirmed a diagnosis of papillary thyroid microcarcinoma. The patient was referred to me for further management.
This scenario of an incidentally discovered small papillary thyroid cancer is all too common. In the United States, the incidence of thyroid cancer increased 300% in the past four decades, with the largest increase noted in tumors ≤ 2 cm (annual percentage change, 6.8%) and in papillary thyroid cancer subtype (annual percentage change, 1.7%). However, mortality has stayed the same or minimally increased over this time, suggesting that overdiagnosis is the likely cause of the surge in thyroid cancer cases.
How Should We Manage PTMC?
In accordance with the American Thyroid Association guidelinesand the
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COMMENTARY
A New Frontier in Papillary Thyroid Cancer Treatment
Natalia Genere, MD; Juan P. Brito, MD, MS
DisclosuresApril 26, 2021
Editorial Collaboration
Medscape &
A 73-year-old man with prostate cancer and hypertension came to see me for an incidental diagnosis of papillary thyroid microcarcinoma (PTMC). He had undergone fluorodeoxyglucose (FDG) PET with his oncology team because of a rising serum prostate-specific antigen (PSA) level. There were no concerning findings from the prostate cancer perspective, and the PSA level subsequently declined. However, a small FDG-avid thyroid nodule was incidentally discovered.
Ultrasound revealed a 7-mm highly suspicious thyroid nodule with no extrathyroidal extension and no suspicious lymph nodes. Cytology from a fine-needle biopsy of the lesion confirmed a diagnosis of papillary thyroid microcarcinoma. The patient was referred to me for further management.
This scenario of an incidentally discovered small papillary thyroid cancer is all too common. In the United States, the incidence of thyroid cancer increased 300% in the past four decades, with the largest increase noted in tumors ≤ 2 cm (annual percentage change, 6.8%) and in papillary thyroid cancer subtype (annual percentage change, 1.7%). However, mortality has stayed the same or minimally increased over this time, suggesting that overdiagnosis is the likely cause of the surge in thyroid cancer cases.
How Should We Manage PTMC?
In accordance with the American Thyroid Association guidelinesand the
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Cite this: A New Frontier in Papillary Thyroid Cancer Treatment - Medscape - Apr 26, 2021.
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Authors and Disclosures
Authors and Disclosures
Authors
Natalia Genere, MD
Instructor, Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
Disclosure: Natalia Genere, MD, has disclosed no relevant financial relationships.
Juan P. Brito, MD, MS
Associate Professor, Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
Disclosure: Juan P. Brito, MD, MS, has disclosed no relevant financial relationships.