Applicability of Dynamic Risk Stratification for Differentiated Thyroid Cancer (DTC) in a Resource Limited Setting
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ORIGINAL ARTICLE
Applicability of Dynamic Risk Stratification for Differentiated Thyroid Cancer (DTC) in a Resource Limited Setting Karthik Munagala1 • S. Vijay Praveen1 • Keerthana Maadam2 • Shamit Chopra3 Sanjay Kishve1
•
Received: 14 May 2020 / Accepted: 12 August 2020 Association of Otolaryngologists of India 2020
Abstract Dynamic risk stratification (DRS) in DTC has been considered necessary to deliver correct follow-up (FU) treatment, avoiding overtreatment of low risk/intermediate risk patients as well as inadequate treatment of high risk patients. However, it’s clinical applicability has been questioned in comparison with more conventional FU protocols. We aimed to know the predictive reliability of DRS in monitoring FU of DTC in a resource-constrained setting across various risk groups, especially when compared with clinical examination alone. Keywords Differentiated thyroid cancer Risk stratification Radio Iodine Thyroglobulin Anti thyroglobulin antibodies
Introduction Thyroid cancer is the most common endocrine malignancy in the world. The incidence of thyroid cancers is about 0.1–0.2% among all the cancers [1] whereas in the United States it is 3.8% [2]. Multiple studies have demonstrated increasing incidence of thyroid malignancy with age; the mean age group being 40–48 years. This has been attributed to some extent with early detection and diagnosis of sub clinical diseases [3].
& Karthik Munagala [email protected] 1
Department of ENT, ESIC Medical College Hospital, Hyderabad, Telangana, India
2
Sunshine Hospital, Hyderabad, Telangana, India
3
Department of HNS, Patel Hospital, Jalandhar, Punjab, India
The prognosis of differentiated thyroid cancer (DTC) for all stages in the US and developed countries remains excellent with a 5 year recurrence free survival of 95–98% [2]. In view of this excellent overall survival and recurrence free survival we advocate the judicious use of investigations and other resources in treatment and followup of patients of thyroid malignancy without compromising clinical outcomes. ATA guidelines [4] are widely accepted as standard of care and they recommend initial risk evaluation and stratification based on the clinical and histo-pathological data. As this risk stratification is done at the time of diagnosis and does not change after initial surgery, it is believed that a proportion of patients on follow-up may receive over treatment with respect to exposure to ionizing radiation, suppressive doses of eltroxin and longer duration of hypothyroidism. To circumvent this issue recently there has been a movement towards the concept of dynamic risk stratification (DRS). This has been introduced to prevent over treating the low risk patients and under treating the high risk patients. This is particularly attractive approach in a resource limited country such as India; especially if results are not compromised. However, at present there is no literature supporting the role of dynamic risk stratification for cancer surveillance. To our knowledge, th
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