Management of Differentiated Thyroid Cancer

Modern risk-adapted management of thyroid cancer involves risk stratification as an active, dynamic process that begins with the detection of a thyroid nodule and continues throughout the clinical course of diagnosis, active surveillance or treatment, and follow-up. Rooted in clinicopathological staging, which can be further refined with the molecular risk characterization of the tumor, initial management plans are developed and modified over time on the basis of the natural history of the disease and the response to therapy. We present a clinical framework for therapeutic decision making that can be used to compare, contrast, and illustrate the relative risks, benefits, and patient preferences that are integral to the development of a personalized management plan. We examine examples of therapeutic decision making in active surveillance of low-risk papillary thyroid cancer, minimalist therapeutic management options for low- and intermediate-risk thyroid cancer, and systemic therapies for advanced thyroid cancer, showing how the therapeutic decision-making framework can be used to achieve informed consensus and management recommendations.