Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Differentiated thyroid cancer: Clinicopathologic staging

R Michael Tuttle, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Clinicopathologic staging of patients with cancer is valuable for many reasons, including the following:

To estimate risk of recurrence and disease-specific mortality for an individual patient

To tailor decisions regarding postoperative adjunctive therapy (such as the need for radioiodine ablation and degree of thyroid-stimulating hormone [TSH] suppression) to the patient's risk for disease recurrence and mortality

To make decisions regarding the frequency, modality, and intensity of follow-up based upon an individual patient's risk of recurrence and mortality

To enable accurate communication regarding a patient among health care professionals


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2017. | This topic last updated: Jan 26, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. AJCC Cancer Staging Manual, 7th Ed, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer-Verlag, New York 2010.
  2. Tuttle RM. Risk-adapted management of thyroid cancer. Endocr Pract 2008; 14:764.
  3. Tuttle RM, Tala H, Shah J, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 2010; 20:1341.
  4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1.
  5. Castagna MG, Maino F, Cipri C, et al. Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur J Endocrinol 2011; 165:441.
  6. Verburg FA, Mäder U, Kruitwagen CL, et al. A comparison of prognostic classification systems for differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2010; 72:830.
  7. DeGroot LJ, Kaplan EL, Straus FH, Shukla MS. Does the method of management of papillary thyroid carcinoma make a difference in outcome? World J Surg 1994; 18:123.
  8. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 1990; 19:545.
  9. Wada N, Nakayama H, Suganuma N, et al. Prognostic value of the sixth edition AJCC/UICC TNM classification for differentiated thyroid carcinoma with extrathyroid extension. J Clin Endocrinol Metab 2007; 92:215.
  10. Rossi R, Roti E, Trasforini G, et al. Differentiated thyroid cancers 11-20 mm in diameter have clinical and histopathologic characteristics suggesting higher aggressiveness than those < or =10 mm. Thyroid 2008; 18:309.
  11. Hay ID, Bergstralh EJ, Goellner JR, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993; 114:1050.
  12. D'Avanzo A, Ituarte P, Treseler P, et al. Prognostic scoring systems in patients with follicular thyroid cancer: a comparison of different staging systems in predicting the patient outcome. Thyroid 2004; 14:453.
  13. Sherman SI, Brierley JD, Sperling M, et al. Prospective multicenter study of thyroiscarcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer 1998; 83:1012.
  14. Verburg FA, Stokkel MP, Düren C, et al. No survival difference after successful (131)I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2010; 37:276.
  15. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167.
  16. Vaisman F, Momesso D, Bulzico DA, et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin Endocrinol (Oxf) 2012; 77:132.
  17. Vaisman F, Tala H, Grewal R, Tuttle RM. In differentiated thyroid cancer, an incomplete structural response to therapy is associated with significantly worse clinical outcomes than only an incomplete thyroglobulin response. Thyroid 2011; 21:1317.
  18. Vaisman F, Shaha A, Fish S, Michael Tuttle R. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2011; 75:112.
  19. Pitoia F, Bueno F, Urciuoli C, et al. Outcomes of patients with differentiated thyroid cancer risk-stratified according to the American thyroid association and Latin American thyroid society risk of recurrence classification systems. Thyroid 2013; 23:1401.
  20. Tuttle RM, Leboeuf R. Follow up approaches in thyroid cancer: a risk adapted paradigm. Endocrinol Metab Clin North Am 2008; 37:419.
  21. Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am 2014; 43:401.
  22. Kim HJ, Sohn SY, Jang HW, et al. Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg 2013; 37:376.
  23. Loh KC, Greenspan FS, Dong F, et al. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 1999; 84:458.
  24. Are C, Hsu JF, Ghossein RA, et al. Histological aggressiveness of fluorodeoxyglucose positron-emission tomogram (FDG-PET)-detected incidental thyroid carcinomas. Ann Surg Oncol 2007; 14:3210.
  25. Ghossein RA, Leboeuf R, Patel KN, et al. Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications. Thyroid 2007; 17:655.
  26. Hiltzik D, Carlson DL, Tuttle RM, et al. Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients. Cancer 2006; 106:1286.