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Thyroid Cancer — SCE Medical Oncology MCQ

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HardHead & Neck CancerThyroid CancerSCE Medical Oncology

Five years after total thyroidectomy and radioiodine for differentiated thyroid cancer, a patient has rising thyroglobulin and enlarging pulmonary metastases on CT. The metastases show no uptake on a properly prepared diagnostic radioiodine scan. How should the disease be classified?

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Correct answer: D — Metastatic differentiated thyroid cancer with proven radioiodine-refractory disease

Structurally progressing differentiated thyroid metastases that fail to take up radioiodine after adequate preparation are proven radioiodine refractory. Metastatic differentiated thyroid cancer with biochemical radioiodine resistance: the case provides structural progression and absent uptake, which is stronger than a biochemical label. Metastatic differentiated thyroid cancer with radioiodine-avid progressive disease: the properly prepared scan shows no metastatic uptake. Metastatic medullary thyroid cancer with structurally progressive pulmonary disease: thyroglobulin secretion and prior radioiodine treatment support differentiated rather than medullary cancer. Metastatic differentiated thyroid cancer with insufficient radioiodine preparation: the stem explicitly states adequate preparation.

Reference: NICE NG230 thyroid cancer: recommendations (Published December 2022; current surveillance): https://www.nice.org.uk/guidance/ng230/chapter/Recommendations; NICE TA535 lenvatinib and sorafenib: recommendations (Published August 2018; current NICE TA): https://www.nice.org.uk/guidance/ta535/chapter/1-Recommendations