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Active surveillance plays an important role in the treatment of patients with radioactive iodine (RAI)-refractory thyroid cancer, since the disease can remain indolent for many years, notes Marcia S. Brose, MD, PhD. Following presentation, Brose recommends a CT scan every 3 months to determine the rate of growth for patients with indolent disease. If no growth is indicated, imaging can safely be reduced to every 6 months. However, for patients with a medical history of rapidly progressing through RAI, early therapeutic intervention is likely warranted, Brose suggests.
Patients with RAI-refractory metastatic thyroid cancer with bulky progressive disease are generally candidates for systemic therapy, notes Manisha H. Shah, MD. In general, in addition to tumor growth rate, the location, volume, and symptoms play an important role in the decision of whether or not to utilize systemic therapy.
Certain histologic subtypes of thyroid cancer are more advanced, suggesting the need for a systemic therapy, Naifa L. Busaidy, MD, states. In general, sclerosing variant of papillary, insular, Hürthle cell, and poorly differentiated thyroid carcinomas are less likely to be RAI-sensitive and more likely to progress. Additionally, certain molecular subtypes are thought to be more aggressive, such as those with BRAF mutations, Busaidy notes.