Systemic treatment for unresectable thyroid carcinoma: Comprehensive approach

Thyroid carcinomas comprise a diverse range of malignancies that all have potential for metastatic spread. They range from microscopic papillary carcinomas, which can be completely in situ or are unlikely to spread beyond local lymphatic regions, to rare and extremely aggressive anaplastic carcinomas that are almost invariably distantly metastatic at the time of diagnosis. Management of the primary tumor is typically initiated with surgical thyroidectomy and some degree of lymph node resection appropriate to the disease presentation. After surgery, thyroid epithelial malignancies of papillary or follicular histologies, including their many variants, receive radioiodine adjuvant therapy and lifelong monitoring. This suffices for the majority of such malignancies. On the other hand, around ten percent of these thyroid cancers, as well as all medullary and anaplastic thyroid cancers, are unable to concentrate radioiodine and require different therapeutic strategies.