According to US and Chinese guidelines, the principles of comprehensive treatment for stage IV differentiated thyroid cancer are as follows:
1. For localized lesions, including those in the thyroid and cervical lymph nodes:
- Surgery is preferred if radical resection by surgery is possible;
- If radical resection is not possible and the lesion is capable of iodine uptake (absorption), surgery followed by radioactive iodine (RAI) treatment of the residual lesion may be indicated;
- If radical resection is not possible and the lesion does not take up iodine, external radiation therapy or targeted drug therapy (e.g., sorafenib, levatinib, etc.) may be an option.
2. For recurrent or metastatic lesions, treatment options include:
- Surgical treatment is preferred if surgical resection is possible;
- RAI treatment if the lesion can take up iodine;
- If the tumor does not progress or progresses slowly and is asymptomatic and does not invade important areas such as the central nervous system, it can be closely monitored with external radiation therapy and endocrine therapy;
- If the lesion is insensitive to RAI therapy and progresses rapidly, chemotherapy and targeted drug therapy can be considered.
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Co-written by Dr. Tingting Zhang, Cancer Hospital of Fudan University