Key Points
Î Patients who present with a rapidly expanding neck mass require rapid
histopathologic confirmation of the diagnosis.
Î If anaplastic thyroid carcinoma (ATC) is diagnosed, the patient's overall
clinical status and TNM stage of the tumor should be determined.
Î Treatment goals (aggressive versus supportive care) should be
established by disclosing the status and risks/benefits, discussing the
patient's values and preferences, and then having the patient make an
informed decision.
Î Patients with stage IVA/IVB resectable disease have the best long-term
survival, particularly if a multimodal approach (surgery, intensity-
modulated radiation therapy [IMRT] for locoregional control, and
systemic therapy) is used.
Î Patients with unresectable stage IVB disease may also respond to
aggressive multimodal therapy.
Î Patients with distant metastases (stage IVC) only rarely have responded
to traditional therapies, and if an aggressive approach is desired by the
patient, a clinical trial should be considered.
Î Hospice or palliative care is also an important component of managing
patients with stage IVC disease.
Table 1. Recommendation Grading
Grade Rating Rating Definition
Strength of Recommendation
S Strong Benefits clearly outweigh risks and burden, or risks and
burden clearly outweigh benefits
W Weak Benefits finely balanced with risks and burden
N None Insufficient evidence to determine net benefits or risks
Quality of Evidence
H High Requires one or more randomized, controlled trials without
important limitations, or overwhelming evidence from
observational studies
M Moderate Derived from trials with important limitations, or
exceptionally strong observational studies
L Low Supported only by observational studies or case series
I Insufficient
for grading
Evidence is lacking, of poor quality, or conflicting
Adapted from: Qaseem A. Ann Intern Med 2010;153:194–199.
