Treatment outcome of high-risk differentiated thyroid carcinoma
Main Article Content
Abstract
High-risk differentiated thyroid carcinoma, is characterized by gross extrathyroidal extension, bulky nodal metastases, or distant metastasis, and is associated with increased recurrence and mortality. This retrospective study evaluated 79 patients with high-risk differentiated thyroid carcinoma who underwent surgery at Hanoi Medical University Hospital between January 2022 and December 2023. Gross extension to the recurrent laryngeal nerve, trachea, and esophagus were observed in 54.4%, 27.8%, and 10.1% of patients, respectively. The most common postoperative complications were hoarseness (25.3%) and paresthesia (29.2%), with persistent complications beyond 6 months reported in 10.1% and 12.7% of patients, respectively. Patients with gross extrathyroidal extension (pT4a) showed a trend toward a higher postoperative complication rates, although the association was not statistically significant (OR = 1.57; p = 0.519). At 6 months after initial treatment, 39,2% of patients achieved an excellent response according to ATA criteria. These findings support the importance of radical surgical resection with cervical lymph node dissection in optimizing locoregional and facilitating postoperative radioactive iodine therapy in high-risk patients.
Article Details
Keywords
Differentiated thyroid carcinoma, high risk, treatment outcome
References
2. H S, J F, Rl S, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3). doi:10.3322/caac.21660
3. Tuttle RM, Tala H, Shah J, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid Off J Am Thyroid Assoc. 2010;20(12):1341-1349. doi:10.1089/thy.2010.0178
4. Vaisman F, Momesso D, Bulzico DA, et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin Endocrinol (Oxf). 2012;77(1):132-138. doi:10.1111/j.1365-2265.2012.04342.x
5. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid®. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
6. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines: Thyroid Carcinoma. Version 1.2025 Accessed May 9, 2026. https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
7. Kuo CY, Yang PS, Chien MN, Cheng SP. Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer. Eur Thyroid J. 2020;9(5):256-262. doi:10.1159/000506474
8. Samargandy SA, Samargandy S, Faruqui HM, Baharoon A, Merdad M, Alsuwat AKM. Age, not tumor size, modifies the association between extrathyroidal extension and long-term outcomes in patients with follicular cell-derived thyroid carcinoma. Ann Saudi Med. 2025;45(6):414-420. doi:10.5144/0256-4947.2025.414
9. Vũ Anh Hải, Mai An Giang. Nhận xét đặc điểm tổn thương và kết quả phẫu thuật điều trị ung thư biểu mô tuyến giáp xâm lấn vỏ bao tuyến. Tạp chí Nghiên cứu Y học. 2024;174(1):43-50. doi:10.52852/tcncyh.v174i1.2075
10. Issa PP, Albuck AL, Hossam E, et al. The Diagnostic Performance of Ultrasonography in the Evaluation of Extrathyroidal Extension in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2022;24(1):371. doi:10.3390/ijms24010371
11. Price DL, Wong RJ, Randolph GW. Invasive thyroid cancer: management of the trachea and esophagus. Otolaryngol Clin North Am. 2008;41(6):1155-x. doi:10.1016/j.otc.2008.08.002
12. Ringel MD, Sosa JA, Baloch Z, et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid Off J Am Thyroid Assoc. 2025;35(8):841-985. doi:10.1177/10507256251363120
13. Qu N, Zhang L, Wu WL, et al. Bilaterality weighs more than unilateral multifocality in predicting prognosis in papillary thyroid cancer. Tumour Biol J Int Soc Oncodevelopmental Biol Med. 2016;37(7):8783-8789. doi:10.1007/s13277-015-4533-5
14. Chen X, Zhong Z, Song M, et al. Predictive factors of contralateral occult carcinoma in patients with papillary thyroid carcinoma: a retrospective study. Gland Surg. 2020;9(4):872-878. doi:10.21037/gs-19-157
15. Wang LY, Nixon IJ, Patel SG, et al. Operative management of locally advanced, differentiated thyroid cancer. Surgery. 2016;160(3):738-746. doi:10.1016/j.surg.2016.04.027
16. Rocke DJ, Mulder H, Cyr D, et al. The effect of lateral neck dissection on complication rate for total thyroidectomy. Am J Otolaryngol. 2020;41(3):102421. doi:10.1016/j.amjoto.2020.102421
17. Dr C. Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg. 2017;6(Suppl 1). doi:10.21037/gs.2017.09.14
18. Sessa L, De Crea C, Voloudakis N, et al. Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas. Ann Surg Oncol. 2024;31(9):5515-5524. doi:10.1245/s10434-024-15356-z
19. van Velsen EFS, Stegenga MT, van Kemenade FJ, et al. Evaluating the 2015 American Thyroid Association Risk Stratification System in High-Risk Papillary and Follicular Thyroid Cancer Patients. Thyroid Off J Am Thyroid Assoc. 2019;29(8):1073-1079. doi:10.1089/thy.2019.0053
20. Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am. 2014;43(2):401-421. doi:10.1016/j.ecl.2014.02.010