Treatment of Persistent or Recurrent Papillary Carcinoma of the Thyroid—The Good, the Bad, and the Unknown

Extract

The diagnosis and treatment of recurrent or persistent papillary carcinoma of the thyroid can pose significant clinical dilemmas. The tumor generally has a relatively indolent biology; however, recurrent or persistent disease is not uncommon, although tumor-specific mortality is infrequent (1). The exquisite detection sensitivity of the combination of TSH-stimulated serum thyroglobulin (Tg) in conjunction with the ease, sensitivity, and availability of ultrasonography [including ultrasound-guided fine-needle aspiration (FNA)] yields a patient cohort with persistent or recurrent disease. The compulsive physician employs these techniques and frequently detects small-volume cervical disease, and the physician in concert with the patient reacts by employing ablative or resectional therapy. Treatment options include ¹³¹I, surgical resection, and ethanol or radiofrequency ablation (2–5). All are capable of destroying target lesions, and ¹³¹I has the advantage of ablating extracervical disease. Each technique has unique, but acceptable, morbidities. Surgery is generally the preferred technique for resectable loco-regional cervical disease (6). Careful observation alone may also be an option in select patients.