De-escalate if possible, intensify when needed: The good, the bad and the ugly: new insights into the full spectrum of thyroid cancer management

This thesis offers tools to personalise future thyroid cancer care: treatment de-escalation if possible and intensification when needed. It first focuses on reducing overtreatment in low risk tumours. When research facilities closed during the pandemic, the downtime was used to study surgical risks in SARS CoV 2 positive patients. Finally, treatment outcomes in aggressive thyroid cancer variants are evaluated and new targets for effective medication are explored.

Chapter 2 shows that observing rather than operating on low risk papillary thyroid cancer (PTC) can reduce costs. Chapters 3 and 4 conclude that molecular fluorescence guided imaging and spectroscopy may stage PTC more accurately by ruling out lymph node metastases and detecting multifocal disease. Chapter 5 demonstrates that a postoperative thyroglobulin test can predict the risk of PTC recurrence.

Chapter 6 describes the increased mortality and complication rates in SARS CoV 2 positive patients who underwent surgery.

Chapter 7 reports that radiotherapy prevents recurrence in poorly differentiated thyroid carcinoma (PDTC) when microscopic tumour remnants remain after surgery, but at the expense of more complications. As detailed in Chapter 8, multimodal therapy likewise reduces recurrence and improves survival in anaplastic thyroid carcinoma (ATC), yet again with higher complication rates. Finally, Chapter 9 identifies MTOR, MET, WEE1, PSMD1, MERTK, FGFR3, RARG and ESR2 as promising therapeutic targets for ATC.