Differentiated Thyroid Cancer-Treatment: State of the Art

Int J Mol Sci. 2017 Jun 17;18(6):1292. doi: 10.3390/ijms18061292.


Differentiated thyroid cancer (DTC) is a rare malignant disease, although its incidence has increased over the last few decades. It derives from follicular thyroid cells. Generally speaking, the prognosis is excellent. If treatment according to the current guidelines is given, cases of recurrence or persistence are rare. DTC requires special expertise by the treating physician. In recent years, new therapeutic options for these patients have become available. For this article we performed a systematic literature review with special focus on the guidelines of the American Thyroid Association, the European Association of Nuclear Medicine, and the German Society of Nuclear Medicine. For DTC, surgery and radioiodine therapy followed by levothyroxine substitution remain the established therapeutic procedures. Even metastasized tumors can be cured this way. However, in rare cases of radioiodine-refractory tumors, additional options are to be discussed. These include strict suppression of thyroid-stimulating hormone (also known as thyrotropin, TSH) and external local radiotherapy. Systemic cytostatic chemotherapy does not play a significant role. Recently, multikinase or tyrosine kinase inhibitors have been approved for the treatment of radioiodine-refractory DTC. Although a benefit for overall survival has not been shown yet, these new drugs can slow down tumor progression. However, they are frequently associated with severe side effects and should be reserved for patients with threatening symptoms only.

Keywords: differentiated thyroid cancer; radioiodine therapy; targeted therapy; tyrosine kinase inhibitors.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adenocarcinoma / classification
  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / therapy*
  • Adenocarcinoma, Follicular / therapy
  • Carcinoma, Papillary / therapy
  • Drug Therapy / standards*
  • Enzyme Inhibitors / therapeutic use
  • Humans
  • Iodine Radioisotopes / standards
  • Iodine Radioisotopes / therapeutic use
  • Neoplasm Metastasis
  • Noonan Syndrome / therapy
  • Prognosis
  • Protein-Tyrosine Kinases / drug effects
  • Protein-Tyrosine Kinases / radiation effects
  • Radiotherapy / standards*
  • Radiotherapy, Adjuvant
  • Thyroid Cancer, Papillary
  • Thyroid Hormones
  • Thyroid Neoplasms / classification
  • Thyroid Neoplasms / diagnosis
  • Thyroid Neoplasms / epidemiology
  • Thyroid Neoplasms / therapy*
  • Thyroid Nodule / diagnosis
  • Thyrotropin / therapeutic use
  • Thyroxine / therapeutic use


  • Enzyme Inhibitors
  • Iodine Radioisotopes
  • Thyroid Hormones
  • Thyrotropin
  • Protein-Tyrosine Kinases
  • Thyroxine