Anaplastic Thyroid Carcinoma Guidelines

Updated: May 08, 2018
  • Author: Anastasios K Konstantakos, MD; Chief Editor: Neetu Radhakrishnan, MD  more...
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Guidelines

Guidelines Summary

Guidelines Contributor:  Kemp M Anderson Medical University of South Carolina College of Medicine

The following organizations have released guidelines for the diagnosis and/or management of thyroid cancer:

  • American Thyroid Association (ATA) [23, 24]
  • National Comprehensive Cancer Network (NCCN) [25]
  • American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi/European Thyroid Association (AACE/AME/ETA [26]  (diagnosis only)

Diagnosis

All the guidelines advocate ultrasound evaluation of thyroid nodules along with measurement of serum thyroid-stimulating hormone (TSH) levels to determine whether a fine needle aspiration biopsy (FNAB) is indicated. A routine measurement of serum thyroglobulin (Tg) for the initial evaluation of thyroid nodules is not recommended because Tg levels are elevated in most benign thyroid conditions. [23, 25, 26]

Although all the guidelines recommend FNAB as the procedure of choice in the evaluation of solid thyroid nodules, there is variance in the size of the nodule as an indication for FNAB, as follows [23, 25, 26] :

  • >0.5 cm in diameter (ATA) [23]
  • >1 cm, in the absence of suspicious sonographic features (AACE/AME/ETA) [26]
  • >1 cm if suspicious sonographic features are present; >1.5 cm if no suspicious sonographic features are present (NCCN) [25]

AACE/AME/ETA and NCCN suggest a serum calcitonin assay as an optional test,  [25, 26]  but the ATA guidelines make no recommendation on the routine measurement of serum calcitonin because of insufficient evidence.  [23]  All three guidelines recommend radionuclide imaging in patients with a low TSH level. [23, 25, 26]

Treatment

No curative treatment currently exists for anaplastic thyroid cancer (ATC). The majority of patients present with unresectable or metastatic disease. National Comprehensive Cancer Network (NCCN) guidelines recommend attempting total thyroidectomy in patients with resectable disease. [25]

The 2012 American Thyroid Association (ATA) guidelines recommend total lobectomy or total or near-total thyroidectomy with a therapeutic lymph node dissection for patients with intrathyroidal ATC. In patients with extrathyroidal invasion, an en bloc resection should be considered if grossly negative margins (R1 resection) can be achieved. [24]  Both the NCCN and ATA guidelines recommend adjuvant radiation therapy, chemotherapy, or both. [24, 25]