Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma - Review

Sep 21, 2026

Multidisciplinary Canadian consensus recommendations address high-risk and radioactive iodine–refractory differentiated thyroid carcinoma (RAIRTC), distinguishing more aggressive differentiated cancers from poorly differentiated and anaplastic variants. The guidance synthesizes clinical, radiographic, and molecular features to support multimodal treatment algorithms based on risk–benefit assessments. Because evidence remains scarce for this rare but highly aggressive condition, the consensus is designed to provide practical direction for endocrinology, oncology, pathology, radiation oncology, and surgical teams in optimizing patient management.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Introduction

Key rationale for RAIRTC management

TYPE Review PUBLISHED 04 November 2024 DOI 10.3389/fonc.2024.1437360 OPEN ACCESS EDITED BY Sharon R. Pine, University of Colorado, United States REVIEWED BY Ming Song, Sun Yat-sen University Cancer Center (SYSUCC), China Frank Berger, LMU Munich University Hospital, Germany *CORRESPONDENCE Shereen Ezzat [Shereen.Ezzat@uhn.ca](Shereen.Ezzat@uhn.ca) RECEIVED 23 May 2024 ACCEPTED 10 September 2024 PUBLISHED 04 November 2024 CITATION Ezzat S, Pasternak JD, Rajaraman M, Abdel-Rahman O, Boucher A, Chau NG, Chen S, Gill S, Hyrcza MD, Lamond N, Massicotte M-H, Winquist E and Mete O (2024) Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma. Front. Oncol. 14:1437360 . doi: 10.3389/fonc.2024.1437360 COPYRIGHT © 2024 Ezzat, Pasternak, Rajaraman, Abdel-Rahman, Boucher, Chau, Chen, Gill, Hyrcza, Lamond, Massicotte, Winquist and Mete. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma Shereen Ezzat 1*, Jesse D. Pasternak 2, Murali Rajaraman 3, Omar Abdel-Rahman 4, Andr´ee Boucher 5, Nicole G. Chau 6, Shirley Chen 1, Sabrina Gill 7, Martin D. Hyrcza 8, Nathan Lamond 9, Marie-H´elène Massicotte 10, Eric Winquist 11 and Ozgur Mete 12 1 Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON, Canada, 2 Department of Surgery, University Health Network – Toronto Western Hospital, Toronto, ON, Canada, 3 Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada, 4 Department of Oncology, University of Alberta, Edmonton, AB, Canada, 5 Endocrinology Division, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, 6 Division of Medical Oncology, British Columbia Cancer – Vancouver, Vancouver, BC, Canada, 7 Division of Endocrinology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, 8 Department of Pathology and Laboratory Medicine, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada, 9 Division of Medical Oncology, Nova Scotia Cancer Centre, Halifax, NS, Canada, 10 Division of Endocrinology, Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, 11Verspeeten Family Cancer Centre at London Health Sciences Centre, London, ON, Canada, 12 Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, ON, Canada Most follicular cell-derived differentiated thyroid carcinomas are regarded as low-risk neoplasms prompting conservative therapeutic management. Here, we provide consensus recommendations reached by a multidisciplinary group of endocrinologists, medical oncologists, pathologists, radiation oncology specialists, a surgeon and a medication reimbursement specialist, addressing more challenging forms of this malignancy, focused on radioactive iodine (RAI) -resistant or -refractory differentiated thyroid carcinoma (RAIRTC) . In this document we highlight clinical, radiographic, and molecular features providing the basis for these management plans. We distinguish differentiated thyroid cancers associated with more aggressive behavior from thyroid cancers manifesting as poorly differentiated and/or anaplastic carcinomas. Treatment algorithms based on risk-beneﬁt assessments of different multimodal therapy approaches are also discussed. Given the scarcity of data supporting man

FAQs

What is the focus of the multidisciplinary consensus on thyroid cancer management?

The consensus provides recommendations for multimodal management of high-risk and radioactive iodine–refractory differentiated thyroid carcinoma (RAIRTC), integrating clinical, radiographic, and molecular perspectives.

Why does RAIRTC develop after radioactive iodine therapy?

RAIRTC typically develops through changes in functional differentiation status, often including loss of the sodium iodide symporter needed for iodine uptake.

What is emphasized for early identification of RAIRTC?

Early identification and prediction are considered critical due to limited benefit from repeated radioactive iodine therapy and the availability of effective targeted regimens such as VEGFR tyrosine kinase inhibitors.

Sep 21, 2026

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