Thyroid Disease: Updates from Diagnosis to Treatment

Dear Colleagues,

Thyroid disorders are frequently encountered in clinical daily life, and their diagnosis and therapy may involve different specialists using different methods. Laboratory tests and imaging procedures are integral to the diagnosis and management of thyroid disease. An appropriate integration of laboratory, imaging and (cyto)pathology data is pivotal for refining the diagnosis and selecting patients for different available therapies. In addition, radioiodine (i.e., I-131) therapy was the first application of the theranostic approach in clinical practice and is widely used in patients with differentiated thyroid cancer, hyperthyroidism and non-toxic compressive goiter since the 1940s. Accordingly, thyroid diseases represent an ideal platform to develop and evaluate integrated diagnostic and theranostic strategies. The present issue aims to provide relevant information on different diagnostic methods actionable in thyroid patients and their rationale integration (i.e., integrated diagnostics). Furthermore, surgical, pharmacologic and theragnostic applications for patients with either benign or malignant thyroid diseases will also be illustrated. We invite specialists in clinical thyroidology, endocrine surgery, imaging and theranostics, laboratory and (cyto)pathology to share their experience and contribute with original research and reviews to our present issue.

Prof. Dr. Luca Giovanella
Dr. Petra Petranović Ovčariček
Guest Editors

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• autoimmune thyroid diseases
• thyroiditis
• thyroid cancers
• PET/CT
• hyperthyroidism

Title: OLDIE BUT GOLDIE… THE FUNDAMENTAL ROLE OF RADIOIODINE IN THE MANAGEMENT OF THYROID CANCER
Authors: Alfredo Campennì
Affiliation: Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali; Università di Messina, Messina, Italia.
Abstract: Background: The management of differentiated thyroid cancer (DTC) patients underwent a major paradigm shift in the past years, especially regarding the role of a careful postoperative disease assessment both in deciding for or against the use of iodine-131 therapy (i.e. patients’ selection) and for selecting the correct goal of the treatment: ablative, adjuvant or therapeutic. Furthermore, a diagnostic and risk-oriented use of iodine isotopes (i.e. 123/124/131I) should always be considered during both postoperative assessment and follow-up of DTC patients to improve early staging and response assessment to initial treatments, respectively. The present review summarizes on current (and real life-related) evidence and the emerging perspectives of the therapeutic, diagnostic and, theragnostic use of radioiodine isotopes. Methods: A review of the pertinent literature was performed in PubMed, Web of Science, and Scopus without language restrictions or time limits using one or more fitting search criteria and terms. Results and Conclusion: According to literature evidence and clinical real-life practice, a risk-oriented postoperative iodine-131 therapy remains pivotal for most DTC patients also for improving early disease staging by post-therapy functional imaging (i.e. theragnostic aim). Accordingly, the goal of iodine-131 therapy, the optimal strategy (empiric vs dosimetric approach), the appropriate stimulation method (i.e. L-T4 withdrawal vs rhTSH-administration) and, finally, the suggested radioiodine activity to deliver for iodine-131 therapy should be personalized, especially in metastatic DTC patients. Finally, the evidences related to the diagnostic and theragnositc use of iodine isotopes lead to a significant improvement of postoperative risk stratification and staging of DTC patients other than a more accurate assessment of the response to initial treatments. In conclusion, radioiodine is really an oldie but goldie radiotracer having both a current fundamental role and future perspective for an always more careful management of DTC patients.