Differentiated Thyroid Carcinoma: Basic Aspects of Diagnosis, Therapy, and Follow-up from a Nuclear-Medicine Perspective

Differentiated thyroid carcinoma is the most common neoplasm of the endocrine glands. Both papillary and follicular thyroid carcinoma have a favourable prognosis. The challenge in the diagnostic work-up of nodular goitre is to discriminate the few malignant from the majority of benign nodules. Even though the specificity of ultrasound criteria for malignancy is high, the sensitivity is proven to be quite low. Thus, further scintigraphic techniques and ultrasound-guided fineneedle aspiration biopsy are well-established in clinical routine. In contrast to anaplastic and medullary thyroid carcinoma, radioiodine remnant ablation is a standard procedure subsequent to surgery for patients with differentiated thyroid carcinoma > 1 cm. Only few advanced differentiated thyroid carcinomas may lose the ability to accumulate I-131, thus, radioiodine ablation may be ineffective in these cases. For this group of tumours with a worse prognosis, miscellaneous therapeutic strategies are undergoing clinical testing.