Volume 7 Issue 10, October 2011

Thyroid nodules are frequent clinical findings, but only a small proportion is malignant. Differential diagnosis and risk stratification for thyroid malignancy is, therefore, required to avoid unnecessary surgery. Could immunostaining of two protein markers ramp up a clinician's ability to distinguish lesions that require surgical intervention from those that do not?

30 years have passed since the first trials of immunotherapy aimed to halt the progression of autoimmune type 1 diabetes mellitus. Today, these efforts are beginning to pay off by generating real hope. Results from recent extensive phase II and III trials lay the foundation for the design of future studies.

The increasing diversity of patient groups and rising prevalence of vitamin D deficiency highlight a pressing need for consensus-based guidance in terms of the evaluation, treatment and prevention of this condition. Following the Institute of Medicine's population-based recommendations, the Endocrine Society attempts to provide clear guidelines for clinicians but runs the risk of adding to the confusion.

Knowledge of genetic alterations occurring in thyroid cancer has rapidly expanded in the past decade. This Review discusses genetic alterations in follicular cell-derived thyroid cancers and outlines new insights into thyroid cancer etiology; in addition, the article describes how mutational markers can be used to improve cancer diagnosis and prognostication.

Thyroid cancer is the most common malignancy of the endocrine system and well-differentiated thyroid cancers (DTCs) represent >90% of thyroid malignancies. This Review outlines the current surgical management of DTC and provides an overview of the controversies surrounding the optimal surgical scheme. The recent advances in thyroid surgery, the arguments for and against each surgical approach, and the authors’ personal opinions are also presented.

Many questions remain about the efficacy of radioiodine treatment for thyroid remnant ablation and therapy of advanced differentiated thyroid cancer. This Review intends to answer some of these questions taking into account novel insights into the treatment and (re)staging of patients with metastatic disease.

Medullary thyroid carcinoma is a rare endocrine malignancy that, when diagnosed during childhood, is almost always associated with multiple endocrine neoplasia type 2 and a germline mutation in theRETproto-oncogene. This Review discusses a contemporary approach to the diagnosis and treatment of medullary thyroid carcinoma and multiple endocrine neoplasia type 2 syndromes in the pediatric population.

The cellular origin of thyroid cancer has not been fully elucidated. The author of this Review discusses the different mechanisms by which thyroid cancer stem cells might contribute to the development of thyroid cancer and the potential of stem-cell-based diagnostic and therapeutic strategies to improve the management of patients with thyroid cancer.

Preclinical models have shown that inhibition of kinases in mitogenic and angiogenic signaling pathways can have antitumoral effects. Starting with a brief synopsis of a malignancy that responds well to kinase inhibition (chronic myeloid leukemia) compared with one with less durable responses as yet (melanoma), this Review highlights challenges that must be overcome in order to successfully translate small-molecule therapies to thyroid cancer in the future.

This Perspectives re-evaluates the role of radioiodine treatment following surgery in low-risk patients with undetectable serum thyroglobulin levels after TSH stimulation and without evidence of disease. Moreover, the authors discuss the methods used for preparing low-risk patients for the administration of radioiodine after surgery and the activity of radioiodine that should be administered.