What are the NCCN and ESMO guidelines on the treatment of follicular thyroid carcinoma (FTC)?

Updated: Jun 18, 2020
  • Author: Luigi Santacroce, MD; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

The treatment of choice for differentiated thyroid cancers is surgery, whenever possible, followed by radioiodine (131I) in selected patients and thyrotropin suppression in most patients, according to the National Comprehensive Cancer Network (NCCN) guidelines. [1]

The NCCN guidelines recommend lobectomy plus isthmusectomy as the initial surgery for patients with follicular neoplasms and Hürthle cell carcinomas, with prompt completion of thyroidectomy if invasive cancer is found on the final histologic section. Therapeutic neck dissection of involved compartments is recommended for clinically apparent/biopsy-proven disease.

The NCCN recommends total thyroidectomy as the initial procedure only if invasive cancer or metastatic disease is apparent at the time or surgery, or if the patient wishes to avoid a second, completion thyroidectomy should the pathologic review reveal cancer. [1]

While ESMO guidelines consider thyroidectomy to be standard of care for other thyroid tumors, they recommend proposing active ultrasound surveillance of every 6–12 months for unifocal papillary microcarcinomas (≤10 mm) with no evidence of extracapsular extension or lymph node metastases. Lobectomy (instead of total thyroidectomy) may be proposed for selected low-risk (T1a–T1b–T2, N0) tumors. [38]


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