October - December 2024, Volume 20, Issue 4

Mihai R, Cetinoglu I, Roman S, Sosa JA

The Gap between Guidelines and Practice: The Need to De-Escalate Intensity of Treatment for Differentiated Thyroid Cancer

Acta Endo (Buc) 2024, 20 (4): 501-507
doi: 10.4183/aeb.2024.501

Differentiated thyroid cancer (DTC) generally has an excellent prognosis, yet treatment strategies have traditionally been aggressive, often involving total thyroidectomy followed by radioactive iodine (RAI) ablation and long-term suppressive levothyroxine therapy even in cases considered to be low- or intermediate-risk. In recent years, several guidelines have recommended a more individualized, risk-based approach aiming for a more conservative treatment plan. Despite this paradigm shift, there is a gap between recommendations and actual clinical practice as many centers continue to advocate the more aggressive treatment model. De-escalating the care of selected patients with thyroid cancer include the avoidance of surgery in tumours < 10 mm, the recommendation for thyroid lobectomy for tumours < 4cm, the avoidance of prophylactic lymph node dissection. Evidence based studies show that such strategies do not worsen long-term outcomes, can reduce complications and can lead to better quality of life. Such studies will be summarised in this editorial with the aim of encouraging clinicians to reconsider established treatment protocols and empowering patients to make informed decisions for their care.

Keywords: thyroid cancer, de-escalation, guidelines, risk stratification

Correspondence: Radu Mihai MD PhD FRCS, Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust Oxford, UK, E-mail: radumihai@doctors.org.uk