European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium

Thyroid carcinoma is rare among human malignancies (<1%) but is the most frequent endocrine cancer, accounting for about 5% of thyroid nodules (1). The latter are very frequent in the general population and, according to the method of detection and the age of the patients, their prevalence may approach 20–50% of the general population, thus representing a daily issue in endocrine clinics. Furthermore, the incidence of thyroid cancer, mainly differentiated, is one of the most rapidly increasing human cancers, at least in the United States (2), with the papillary histotype being the most frequent (nearly 80%). There is a need for uniform diagnostic and treatment strategies for thyroid nodules and differentiated thyroid cancer (DTC) since the disease requires a multidisciplinary approach, including endocrinology, internal medicine, nuclear medicine, oncology, endocrine (general or head and throat) surgery and even general practice operating in different settings not always equipped with the appropriate services (such as specialized centers, general hospitals and peripheral centers). Not infrequently among European countries, epidemiology may differ according to different environment, probably reflecting different clinical practice or pathogenetic factors, which may change the presentation and the management strategy. In addition, in recent decades, the clinical presentation of differentiated thyroid cancer has been changing from advanced cases requiring intense treatment and surveillance to cancers detected by fortuitous neck ultrasonography (US) requiring less aggressive treatment and follow-up. Diagnostic and treatment tools have also improved in recent years (sensitive assays for serum thyroglobulin measurement, neck US, recombinant human thyrotropin (rhTSH)), thus allowing for less invasive and uncomfortable procedures for the patients. Altogether, these considerations dictate the need for applying the more effective, less invasive and less expensive procedures able to guarantee the best management and the best quality of life for a disease that, albeit having an intrinsic low mortality, requires life-long follow-up care. Several European countries have developed their own guidelines or consensus reports (3–6), based on consolidated experience and cultural attitude of the country. Nevertheless, they differ in several, sometimes important, aspects. Following the spirit of concrete cultural and scientific integration among the countries participating in the new reality of the European Union, the European Thyroid Association (ETA) has endorsed the implementation of this consensus for the management of thyroid nodules and DTC.