Differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) is the most common type of thyroid cancer, arising from the follicular epithelial cells of the thyroid gland. It encompasses two major histological subtypes: papillary thyroid carcinoma (PTC), which accounts for approximately 80-85% of cases, and follicular thyroid carcinoma (FTC), which accounts for approximately 10-15% of cases. Hürthle cell carcinoma is sometimes classified as a variant of follicular carcinoma. DTC typically presents as a painless thyroid nodule discovered on physical examination or incidentally on imaging studies. Regional cervical lymph node enlargement may also be a presenting feature, particularly in papillary thyroid carcinoma. Other symptoms can include hoarseness, dysphagia, or dyspnea if the tumor invades surrounding structures, though these are less common at initial presentation. DTC primarily affects the endocrine system but can metastasize to cervical lymph nodes, lungs, and bones. Risk factors include prior radiation exposure (particularly during childhood), iodine deficiency (more associated with follicular type), and family history of thyroid cancer. Women are affected approximately three times more frequently than men. The prognosis for DTC is generally favorable, with 10-year survival rates exceeding 90% for most patients, though outcomes depend on age at diagnosis, tumor size, extrathyroidal extension, and the presence of distant metastases. Treatment typically involves surgical resection (total or near-total thyroidectomy), often followed by radioactive iodine (RAI) ablation therapy to destroy residual thyroid tissue and potential microscopic disease. Thyroid-stimulating hormone (TSH) suppression therapy with levothyroxine is a standard component of long-term management. For RAI-refractory disease, targeted therapies including multikinase inhibitors such as sorafenib and lenvatinib have been approved. Newer therapies targeting specific molecular alterations, such as BRAF and RET inhibitors, are increasingly used in advanced cases. Long-term surveillance includes serum thyroglobulin monitoring and periodic imaging.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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