Management<unk>  seen on an ultrasound image<unk>  thyroid carcinoma cells<unk>  is considered an emergency cancer diagnosis since it poses a high risk of blocking the airway and/or esophagus due to its rapid growth in the neck, either of which can quickly cause a person's death by asphyxiation, if not immediately corrected. Unlike its differentiated counterparts,<unk>  is highly unlikely to be curable either by surgery or by any other treatment modality, and is in fact usually unresectable due to its high propensity for invading surrounding tissues. A multidisciplinary team including an endocrine pathologist, head and neck surgeon, medical oncologist, radiation oncologist, endocrinologist, and a palliative care physician is essential for optimal management. Palliative treatment consists of radiation therapy usually combined with chemotherapy. The use of tracheostomy as part of supportive care for<unk>  is controversial. Medications, such as fosbretabulin (a type of combretastatin), bortezomib and TNF-Related Apoptosis Induced Ligand (TRAIL), are, however, under investigation in vitro and in human clinical studies. Based on encouraging Phase I and II clinical trial results with fosbretabulin, a type of medication that selectively destroys tumor blood vessels, clinical trials have been evaluating whether the medication can extend the survival of patients with<unk> . With the advent of molecular testing and next-generation sequencing, BRAF and MEK inhibitors are playing an increasing role in the management of patients with<unk>  harboring such mutations. The combination of dabrafenib and trametinib has shown significant increases in overall survival and has been approved by the FDA. Another similar combination is vemurafenib and cobimetinib. Immunotherapy is also starting to play an important role in<unk>  management with several ongoing clinical trials demonstrating promising effects. Specific drugs being tested are atezolizumab, pembrolizumab, and spartalizumab, amongst others. Combinatorial therapy that is molecular-based may lead to significant tumor regression, potentially making patients amenable to curative surgery. Post-operative radiotherapy The role of external beam radiotherapy (EBRT) in thyroid cancer remains controversial and there is no level I evidence to recommend its use in the setting of differentiated thyroid cancers such as papillary and follicular carcinomas.<unk>  thyroid carcinomas, however, are histologically distinct from differentiated thyroid cancers and due to the highly aggressive nature of<unk>  aggressive postoperative radiation and chemotherapy are typically recommended. The National Comprehensive Cancer Network Clinical Practice Guidelines currently recommend that postoperative radiation and chemotherapy be strongly considered. No published randomized controlled trials have examined the addition of EBRT to standard treatment, namely surgery. Radioactive iodine is typically ineffective in the management of<unk>  as it is not an iodine-avid cancer. Imbalances in age, sex, completeness of surgical excision, histological type and stage, between patients receiving and not receiving EBRT, confound retrospective studies. Variability also exists between treatment and non-treatment groups in the use of radio-iodine and post-treatment thyroid stimulating hormone (TSH) suppression and treatment techniques between and within retrospective studies. Some recent studies have indicated that EBRT may be promising, though the number of patients studies has been small. Clinical trials for investigational treatments are often considered by healthcare professionals and patients as first-line treatment. Add on therapy In the absence of extracervical or unresectable disease, surgical excision should be followed by adjuvant radiotherapy. In the 18–24% of patients whose tumour seems both confined to the neck and grossly resectable, complete surgical resection followed by adjuvant radiotherapy and chemotherapy could yield a 75–80% survival at 2 years. There are a number of clinical trials for<unk>  thyroid carcinoma underway or being planned.
Anaplastic thyroid cancer
Thyroid lymphoma
Follicular thyroid cancer
Papillary thyroid cancer
Medullary thyroid cancer
Squamous-cell thyroid carcinoma
Poorly differentiated thyroid cancer
Thyroid adenoma