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Differentiated (papillary / follicular) thyroid cancer (TC) in general has indolent characters and a relatively ‘benign’ biological behavior.

In some cases,  however, this common neoplasm has certain clinicopathological characters which may indicate a dire prognosis.

Factors associated with a high risk for disease recurrence (both locoregional [in the neck] as well as distant metastases) and unfavorable outcome include:

  • Distant metastasis at the time of diagnosis
  • Tumor size > 4 cm
  • Gross extrathyroidal extension (macroscopic invasion of adjacent tissues / structures)
  • Incomplete surgical excision
  • Extensive vascular invasion
  • Presence of positive node > 3 cm
  • Extranodal tumor extension positive with > 3 lymph nodes involved
  • Age > 55 years
  • Follicular TC (as well as medullary TC)- metastasizes to distant sites more commonly than papillary thyroid cancer
  • Aggressive histological variants of differentiated TC (such as tall/columnar variant of papillary thyroid cancer and insular/trabecular variant of follicular TC)
  • Presence of BRAF-V600 mutation (should be evaluated in the context of other standard clinic-pathological risk factors)

The presence of these risk factors should be taken into consideration in the decision-making process regarding postoperative management and follow-up strategy.

J Clin Endocrinol Metab 2017; 102: 1254
Endocrine J 2019; 66: 127
Thyroid 2016; 26: 1

 

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