Controversies in the Management of Intermediate-Risk Differentiated Thyroid Cancer

Background: Intermediate-risk thyroid cancer accounts for up to two-thirds of all cases of differentiated thyroid cancer (DTC), yet it is subject to substantial variations in risk stratification and management strategies.

Methods: This comprehensive review examines the current controversies regarding diagnosis and management of intermediate risk DTC.

Results: The evolution of risk stratification systems is discussed, highlighting limitations such as heterogeneity in patient cohorts, variability in outcome definitions, and the need for more precise risk estimation tools incorporating genetic profiles and individual risk modifiers. The role of radioactive iodine therapy in intermediate-risk DTC is examined, considering evolving evidence, conflicting study results, and the necessity for personalized treatment decisions based on risk modifiers, potential morbidity, and patient preferences. Furthermore, the shift from total thyroidectomy to lobectomy in certain intermediate-risk cases is explored, emphasizing the need for tailored surgical approaches and the impact on long-term outcomes, recurrence rates, and quality of life.

Conclusion: Management of intermediate-risk DTC remains controversial. This review summarizes current evidence to aid decision-making. Further research, prospective trials, and collaboration are crucial to address these complexities and personalize care for patients.