Endocrinology and Metabolism

Review Article

Thyroid
Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines: Min Joo Kim, Jae Hoon Moon, Eun Kyung Lee, Young Shin Song, Kyong Yeun Jung, Ji Ye Lee, Ji-hoon Kim, Kyungsik Kim, Sue K. Park, Young Joo Park; Endocrinol Metab. 2024;39(1):47-60. Published online February 15, 2024; DOI: https://doi.org/10.3803/EnM.2024.1937

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The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.

Citations

Citations to this article as recorded by

2023 Update of the Korean Thyroid Association Guidelines for the Management of Thyroid Nodules
Eun Kyung Lee, Young Joo Park
Clinical Thyroidology®.2024; 36(4): 153. CrossRef

Case Reports

A Case of Incidental Struma Ovarii Confounded with the Metastasis of Papillary Thyroid Cancer.: Young Hee Jung, Sung Min Jung, Jong Min Lee, Yi Sun Jang, In Suk Lee, Jong Ok Kim, Hye Soo Kim; Endocrinol Metab. 2012;27(3):227-231. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.227

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Abstract PDF: A focal radioactive iodine uptake in the pelvis of a patient with differentiated thyroid cancer needs differential diagnosis besides bone metastasis. Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue; 5-10% of these tumors are malignant. As diagnosis and surgery of thyroid cancer have increased recently, incidental cases of struma ovarii, after radioactive iodine treatment, were occasionally reported. Rare cases of ovary metastasis of thyroid cancer were also reported. We report a case of benign struma ovarii incidentally found in a patient with papillary thyroid cancer. The patient showed a sustained high level of thyroglobulin and focal radioactive iodine uptake in the right pelvis, confused with distant metastasis, after total thyroidectomy and radioactive iodine treatment.

Papillary Thyroid Carcinoma Manifesting as an Autonomously Functioning Thyroid Nodule.: Ji Hyun Kim, Gyeong Jae Na, Ki Won Kim, Hee Ja Ko, Sung Wan Jeon, Yeo Joo Kim, Sang Jin Kim, Hyeun Duk Jo, Chang Jin Kim; Endocrinol Metab. 2012;27(1):59-62. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.59

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Abstract PDF

Hyperfunctioning thyroid carcinoma is very rare. Hence, radionuclide imaging of thyroid hot nodules usually suggests a benign tumor, and less than 4% of cases have been reported as malignant. We would like to present a case of a hyperfunctioning papillary thyroid carcinoma that was initially treated with radioactive iodine. A 58-year-old woman was referred to our hospital for palpable thyroid nodule and a 5-kg weight loss within 6 months. Thyroid function test revealed thyrotoxicosis, and thyroid autoantibodies were absent. 99mTc thyroid scintigraphy showed a 2 x 2 cm-sized hyperactive hot nodule at the left lobe. Despite radioactive iodine treatment with a dose of 10 mCi 131I, thyroid function did not improve. Fine needle aspiration revealed papillary thyroid cancer. The patient underwent total thyroidectomy. Although clinical features and thyroid scans suggest a benign nodule, the possibility of malignancy should not be ruled out. Malignant thyroid hot nodules are rare; however, its possibility should be taken into account. Therefore, we suggest that ruling out malignancy by existing diagnostic guidelines can misdiagnose even a typical case with benign features. As thyroid nodule detection is getting sensitive and accurate, we present this case to discuss whether additional diagnostic approaches would be necessary for thyroid nodules.

Citations

Citations to this article as recorded by

Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression
Won Sang Yoo, Hoon Sung Choi
International Journal of Thyroidology.2019; 12(1): 35. CrossRef
Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism
Sung Hye Kong, Seo Young Lee, Ye Seul Yang, Jae Hoon Moon
International Journal of Thyroidology.2016; 9(1): 47. CrossRef

A Case of Papillary Thyroid Carcinoma Combined with Metastatic Renal Cell Carcinoma in the Thyroid.: Kang Il Cheon, Kyung Wook Lee, Ji Oh Mok, Yeo Ju Kim, Hyung Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo, Hee Kyung Kim, Youn Woo Ko; J Korean Endocr Soc. 2006;21(1):85-89. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.85

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Abstract PDF

Metastasis to the thyroid from distant cancer is rarely diagnosed clinically and renal cell carcinoma is the most common group of neoplasm to metastasize to the thyroid. Papillary thyroid carcinoma is known as the most frequent primary thyroid cancer. But coexistence with metastatic renal cell carcinoma to thyroid and papillary thyroid carcinoma is very rare. We are reporting this highly unusual case of metastatic renal cell carcinoma to thyroid, which harbored papillary thyroid cancer. To our knowledge, this is the first case reported in Korea. A 57-year-old woman presented with hoarseness and palpable anterior neck mass. She had a history of renal cell carcinoma of right kidney, which had been resected 10 years previously and had undergone lower anterior resection due to sigmoid colon cancer 2 months before. Fine needle aspiration cytology suggested follicular neoplasm, and total thyroidectomy was performed. The pathology from the thyroid nodules showed papillary thyroid cancer combined metastatic renal cell carcinoma.

Citations

Citations to this article as recorded by

A Case of Metastatic Renal Cell Carcinoma to Thyroid Gland Mimicking as Anaplastic Thyroid Carcinoma
Sooyeon Jo, Hyung Gyun Na, Chang Hoon Bae, Yoon Seok Choi
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2021; 64(10): 755. CrossRef

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