Impact of diagnostic procedures and treatment on outcome in differentiated thyroid cancer

Deborah van Dijk

    Research output: ThesisThesis fully internal (DIV)

    135 Downloads (Pure)

    Abstract

    Thyroid cancer is rare. With the increase of sophisticated diagnostic imaging modalities, the number of early diagnosed thyroid cancer has increased. There are different types of thyroid cancer, about 90% consists of papillary and follicular thyroid cancer, together referred to as differentiated thyroid cancer (DTC). Thyroid cancer is generally treated by operative and radioactive iodine (131I) treatment. In this dissertation diagnostics and treatment of DTC is evaluated. Low risk tumors > 1cm can be treated with a hemithyroidectomy and follow-up. Patients with detectable thyroglobulin (Tg), as a sign of residual tumor tissue after thyroid surgery, without residual uptake on the 131I scan, have earlier and more frequent recurrences, but do not have shorter life expectancy. In patients whom are unresponsive to 131I therapy a PET scan shows additional tumor tissue in about 20%. Additional radiotherapy is an effective treatment for locoregional control in the neck in this group. In 2015 the Dutch thyroid cancer guideline was revised, which aims to optimize thyroid cancer treatment. Evaluation of the period before the guideline, in which surgeries were performed in all hospitals, shows a high complication rate after the first surgery and after re-surgery. Standardization of care and discussion in regional multidisciplinary tumor boards could lead to more uniformity of care and potentially diminish complications. Compared with the American thyroid cancer guidelines recommendations from the Dutch guidelines are more extensive and that is not always necessary, pleading for a further de-escalation of treatment.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Plukker, John, Supervisor
    • Links, Thera, Supervisor
    • van Dijk, Boukje, Co-supervisor
    Award date7-Sept-2022
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6423-925-6
    DOIs
    Publication statusPublished - 2022

    Cite this