Controversies in the Follow-up of Differentiated Thyroid Cancer: An Analysis from the Cuban Context
Keywords:
Differentiated thyroid cancer; follow-up; controversiesAbstract
This article analyzes the main controversies surrounding the follow-up of differentiated thyroid cancer (DTC) and its applicability within the Cuban healthcare system.Four key debates are highlighted: 1) the shift from static risk stratification to continuous dynamic assessment based on treatment response;2) the central role of high-sensitivity thyroglobulin and cervical ultrasound, along with the challenges of interpretation;3) the paradigm shift toward selective and non-routine use of radioactive iodine (I-131);and 4) active surveillance as a valid option for papillary microcarcinoma.From the Cuban perspective, strengths such as an integrated healthcare system and specialized training are identified, but challenges such as unequal access to advanced diagnostic technologies and the need for a cultural shift are also highlighted.The article proposes intelligently adapting international guidelines through the formal adoption of dynamic stratification, strengthening diagnostic capabilities, individualizing I-131 through multidisciplinary consensus, and evaluating a pilot active surveillance program.The ultimate goal is to maintain the excellent historical oncology results by moving towards a more personalized, less invasive and sustainable approach.
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1. Hoff AO, de Castro ALF, Oliveira TBO. Differentiated thyroid carcinoma: what the nonspecialists needs to know. Arch Endocrinol Metab. 2024;68:e230375. DOI: https://doi.org/10.20945/2359-4292-2023-0375
2. Reverter JL. Thyroid cancer. Med Clin (Barc). 2025;164(8):421-8. DOI: https://doi.org/10.1016/j.medcli.2024.12.005
3. Abelleira E, Bueno F, Smulever A, Pitoia F. Riesgo dinámico en pacientes con cáncer diferenciado de tiroides no ablacionados. Rev Argent Endocrinol Metab. [acceso 13/11/2025];2017;54(2):69-75. Disponible en: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1851-30342017000200003
4. Alshehri M, Aljada A, Alsaif F, Alsaadi M. Controversies in the Management and Followup of Differentiated Thyroid Cancer: A Review. Int J Endocrinol. 2012;2012:512401. DOI: https://doi.org/10.1155/2012/512401
5. Celnovte. Descifrando los anticuerpos contra la tiroglobulina: una guía clínica. 2024. [acceso 13/11/2025]. Disponible en: https://www.celnovte.com/es/solution/unraveling-thyroglobulin-antibody-a-clinical-guide/
6. Orosa A, Mora M, Halperin I, Oriola J. Carcinoma diferenciado de tiroides familiar: más allá de las formas sindrómicas. Endocrinol Diabetes Nutr. 2021;68(4):260-9. DOI: https://doi.org/10.1016/j.endinu.2020.07.009
7. Noboa M, Figueredo A, de León A. Insufficient elevation of TSH before therapy with I131 in a patient with follicular thyroid carcinoma and bone metastasis. Rev Argent Endocrinol Metab. 2023;80(2):149-52. DOI: https://doi.org/10.31053/1853.0605.v80.n2.38112
8. Tamayo-Alonso P, Martín-Gómez E, García-Talavera P, Cañadas-Salazar J, Peñaherrera-Cepeda C, Díaz-González L. Actualización del tratamiento del cáncer de tiroides con radioyodo. Rev ORL. 2021;12(4). DOI: https://doi.org/10.14201/orl.25746
9. American Thyroid Association. Controversies, consensus, and collaboration in the use of radioactive iodine therapy for the treatment of thyroid cancer. Clin Thyroidol Public. 2020 [acceso 13/11/2025];13(5):15-6. Disponible en: https://www.thyroid.org/patient-thyroid-information/ct-for-patients/may-2020/vol-13-issue-5-p-15-16/
10. Russell Center for Thyroid Surgery. Microcarcinoma papilar de tiroides (PTMC). [acceso 13/11/2025]. Disponible en: https://russell-center.com/es/conditions/papillary-thyroid-microcarcinoma-ptmc/
11. Leite AKN, Bufalo NE, Carvalho GA. Importance of dynamic risk stratification and long-term follow-up in thyroid cancer. Arch Endocrinol Metab. 2023;67(2):e000602. DOI: https://doi.org/10.20945/2359-3997000000602
12. Instituto Nacional de Oncología y Radiobiología. Informe anual 2023. La Habana: INOR. 2024 [acceso 13/11/2025]. Disponible en: https://especialidades.sld.cu/oncologia/category/actualidad/
13. Ministerio de Salud Pública. Anuario Estadístico de Salud 2023. La Habana: MINSAP; 2024 [acceso 13/11/2025]. Disponible en: https://temas.sld.cu/estadisticassalud/2025/09/30/an
14. Haugen BR, Alexander EK, Bible KC. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. DOI: https://doi.org/10.1089/thy.2015.0020
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