Papillary, follicular, medullary, and anaplastic carcinomas: surgery + radioiodine + targeted therapy
Thyroid cancer is one of the few forms of oncology with a high survival rate when treated promptly, but the choice of strategy is critically important: excessive therapy for papillary microcarcinoma is as harmful as insufficient treatment for aggressive subtypes. At the Ichilov (Sourasky) Medical Center in Tel Aviv, all treatment is built around an interdisciplinary approach: an endocrinologist, endocrine surgeon, oncologist, radiologist, nuclear medicine specialist, and pathomorphologist jointly manage the patient from ultrasound to long-term follow-up.
Diagnosis at the clinic includes thyroid ultrasound with TI-RADS assessment, ultrasound-guided fine-needle aspiration biopsy with molecular analysis of Bethesda III–IV nodules (ThyroSeq/Afirma panels), scintigraphy with ¹²³I or technetium, calcitonin in suspected medullary cancer, and PET-CT with F-18-FDG for aggressive forms. Determining the histological subtype and molecular profile (BRAF V600E, RET, NTRK, ALK) directly dictates the extent of surgery and subsequent treatment.
Surgical arsenal: total and subtotal thyroidectomy with central or lateral neck lymphadenectomy, minimally invasive access (mini-invasive and robot-assisted thyroidectomy), organ-preserving interventions for microcarcinomas, transesophageal access (TOETVA) — without an incision on the neck. After surgery for high-risk tumors, radioiodine ablation (¹³¹I) is performed, and for iodine-refractory forms — targeted therapy (lenvatinib, sorafenib, selpercatinib, cabozantinib, larotrectinib) and clinical trials of new drugs.
This hub brings together articles on all histological types (papillary, follicular, medullary, anaplastic, Hurthle cell carcinomas), protocols for radioiodine therapy and targeted therapy, as well as leading endocrine surgeons and oncologists at Sourasky.