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KMID : 1011720230160010089
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International Journal of Thyroidology
2023 Volume.16 No. 1 p.89 ~ p.95
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Thyroid Cancer, Iodine, and Gene Mutation
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Chung Jae-Hoon
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Abstract
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Excessive iodine intake is associated with the development of papillary thyroid carcinoma and increases the expression of BRAF mutations. In order to prevent most patients with thyroid cancer from unnecessary treatment, it is important to distinguish the patients who need aggressive treatment from those who do not. Although conventional prognostic systems alone have limitations, adding molecular tests can more accurately predict the final outcome of each patient, because molecular changes precede histological changes. Although BRAF mutation has drawn much attention on its high prevalence, it cannot predict the clinical outcome of each patient. It was no longer significant after the adjustment with other prognostic factors. The isolated BRAF mutation may be a sensitive, but not specific marker of recurrence and mortality. Recently, telomerase reverse transcriptase (TERT) promoter mutation has been identified in thyroid cancer. It increases telomerase activity, which allows cancer cells to immortalize. It was found in 10 to 20% of differentiated thyroid carcinoma and more than 40% of dedifferentiated thyroid carcinoma. It is highly prevalent in old age, large tumor, aggressive histology, advanced stages, and distant metastasis. It is strongly associated with increased recurrence and mortality, therefore, aggressive treatment is required in patients with TERT promoter mutation. Concomitant BRAF and TERT promoter mutations show the most aggressive clinical outcomes. When ultrasonography shows nonparallel orientation and microlobulated margins, especially in those older than 50 years, there is a high probability of accompanying TERT promoter mutation. Inclusion of TERT promoter mutation analysis with conventional clinicopathological evaluation can lead to better prognostication and management for individual patients.
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KEYWORD
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Thyroid carcinoma, Iodine, BRAF mutation, TERT promoter mutation
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