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Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-Up

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Tuttle, R Michael, Alzahrani, Ali S·2019·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2019-00177PMC PMC6684308
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Abstract

Context: Modern management of differentiated thyroid cancer requires individualized care plans that tailor the intensity of therapy and follow-up to the estimated risks of recurrence and disease-specific mortality. Design: This summary is based on the authors’ knowledge and extensive clinical experience, supplemented by review of published review articles, thyroid cancer management guidelines, published staging systems, and original articles identified through a PubMed search, which included terms such as risk stratification, staging, clinical outcomes, and differentiated thyroid cancer. Main Outcome Measures: In the past, risk stratification in differentiated thyroid cancer usually referred to a static estimate of disease-specific mortality that was based on a small set of clinicopathological features available within a few weeks of completing initial therapy (thyroidectomy, with or without radioactive iodine). Today, risk stratification is a dynamic, active process used to predict the appropriateness for minimalistic initial therapy, disease-specific mortality, risk of recurrence, and the most likely response to initial therapy. Rather than being a static prediction available only after initial therapy, modern risk stratification is a dynamic, iterative process that begins as soon as a suspicious nodule is detected and continues through final follow-up. Conclusions: Dynamic risk assessment should be used to guide all aspects of thyroid cancer management, beginning before a definitive diagnosis is made and continuing through the final follow-up visit.

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  • PDT can be used in outpatient settings.

    “The main advantages of PDT include low therapy costs compared to other methods in oncological treatment, short therapy time, no long-term side effects, low invasiveness, possibility of use in outpatient settings, high effectiveness in killing cancer cells, also affecting the vascularization of the tumor, possibility of repeated use, no interaction with other treatment methods, leaving small scars”

    From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [30]

    The Abstract discusses active surveillance, surgery, radioactive iodine and other treatments for differentiated thyroid cancer, but does not address photodynamic therapy (PDT). Searches of the indexed full text for PDT, photodynamic therapy and outpatient treatment found no passage about whether PDT can be used in outpatient settings. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • PDT has high effectiveness in killing cancer cells and affects tumor vascularization.

    “high effectiveness in killing cancer cells, also affecting the vascularization of the tumor”

    From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [30]

    The passages on predicting response to therapy discuss molecular risk profiles and possible treatments for differentiated thyroid cancer, but do not address photodynamic therapy (PDT). Searches for PDT, cancer-cell killing, and tumor vascularization found no passage supporting the attributed claim. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • The main disadvantage of PDT is pain caused by ROS affecting nociceptors.

    “The main disadvantage of PDT is related to ROS, which causes pain by affecting nociceptors.”

    From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [30]

    The passages on thyroid-cancer risk stratification and response to therapy do not address photodynamic therapy (PDT). Searches of our full-text copy for PDT, reactive oxygen species, nociceptors, and pain found no passage supporting the claimed mechanism. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In PDT, photosensitizer absorbing light triggers chemical reactions generating reactive oxygen species and transitions PS to excited singlet state; type II reaction via singlet oxygen is the main mechanism of action.

    “Absorbing light, it triggers numerous chemical reactions that result in the generation of reactive oxygen species and the transition of PS from the ground state to an unstable electronically excited singlet state.”

    From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [30]

    The passages in ‘Predicting Response to Therapy’ and ‘Use of Dynamic Risk Stratification’ discuss thyroid-cancer outcomes and follow-up, not photodynamic therapy. Searches for photosensitizer excitation, reactive oxygen species, and type II singlet-oxygen reactions found no passage addressing the claim. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • PDT has no long-term side effects.

    “no long-term side effects”

    From Photodynamic Therapy for Thyroid Cancer (2025) · cites this paper as [30]

    The paper’s sections on active surveillance and response to therapy discuss thyroid-cancer outcomes, not PDT or its long-term side effects (page unavailable). Searches for “PDT,” “photodynamic therapy,” and long-term adverse effects found no passage addressing the claim. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Metadata

Authors
Tuttle, R. M., & Alzahrani, A. S.
Affiliations
  • Memorial Sloan Kettering Cancer Center (US)
  • King Faisal Specialist Hospital & Research Centre (SA)
Corresponding author
Tuttle, R Michael
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2019-03-15
Volume
104
Issue
9
Pages
4087-4100
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2019-00177
PMC
PMC6684308
OpenAlex
W2921866665
Cited by
175
References
0
Citations by year
2026: 23 · 2025: 28 · 2024: 21 · 2023: 29 · 2022: 28 · 2021: 25 · 2020: 20 · 2019: 1
FWCI
15.02
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute (P30 CA008748)
  • Special Program of Research Excellence, SPORE in Thyroid Cancer (P50 CA172012-01A1)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords
differentiated thyroid cancer, risk stratification, thyroid cancer staging, disease-specific mortality, recurrence risk, thyroid nodule detection, thyroidectomy, radioiodine therapy, follow-up, dynamic risk assessment, personalized treatment

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