Case-Based Decision-Making in Progressive DTC

In this segment, Dr. Greg Randolph walks through a case of a 66-year-old patient with differentiated thyroid cancer (DTC) who initially does well after thyroidectomy and radioactive iodine, but later develops cervical nodal recurrence and small pulmonary metastases. He explains how clinicians interpret this pattern as a warning sign of more aggressive biology, especially in the setting of evolving pulmonary disease.

Management starts with careful anatomic mapping of cervical disease using ultrasound and CT to determine whether revision neck dissection is feasible and worthwhile, typically for nodes around 8–10 mm in the central neck or ≥10 mm laterally, depending on distribution, access, and patient comorbidities. Small-volume pulmonary metastases may initially be observed or further evaluated for RAI avidity and suitability for additional RAI or redifferentiation strategies.

If imaging over time confirms radiographic progression, particularly with enlarging pulmonary or mediastinal disease, multidisciplinary input, especially from medical oncology, guides if and when to start TKI therapy.

Supported in part by Eisai, content independently produced by OncLive.