Thyroid cancers (TC), especially differentiated TC (DTCs), are the most common endocrine malignancies with a fast-rising incidence among all cancers in the last 30 years worldwide. The incidence of DTCs also increases with age, and older patients present worse outcomes than younger ones.

One of the challenges in the treatment of thyroid malignancies, especially DTCs, is early diagnosis avoiding false positive or negative results. While no single clinical and radiological test has been proven to show 100% sensitivity and specificity, fine needle aspiration cytology (FNAC) is likely to be considered the most important diagnostic tool for the evaluation and diagnosis of thyroid nodules. FNAC does not provide a diagnosis in up to 20% of nodules, including lesions with cellular atypia, suspicious cytology, and demonstrating a follicular pattern, which provides one of the greatest challenges to researchers in thyroid cancer today. New strategies in interpreting cytological smears of indeterminate or follicular proliferations involve the use of molecular markers. The current molecular markers that have received the most attention in thyroid cancer include BRAF, NRAS, KRAS, HRAS point mutations, and PAX8/PPARG and RET/PTC rearrangements, with the aim to identify (rule-in) thyroid cancer. However, all the various classification systems currently in use for reporting thyroid cytopathology do not include any specific criteria for older patients, although the impact of inappropriate clinical and/or surgical management affects older people more than other subsets of patients.

Older patients, apart from cancer-related prognosis, are also affected by several comorbidities and, in some cases, by the frail syndrome (an age-related clinical entity that has a huge negative impact on survival and disability). Thus, for the treatment choices of older patients with TC, we have to consider not only risks and benefits of any treatment but also the patient’s specific prognosis, independently from cancer. It is worth mentioning that, although older patients’ prognosis depends on several factors, age perse is not a good estimator of clinical outcome and survival.

Although the vast majority of thyroid cancers are generally cured with surgical excision and, sometimes, radioactive iodine therapy, nearly 5% of patients present with distant metastases and poorer prognosis. For the elderly, surgical choice should be well balanced for the related cost/benefits. Moreover, with the introduction of target therapy for DTCs and the potential use of immunotherapy (e.g., in undifferentiated and anaplastic carcinoma), the risk stratification of older patients represents an important challenge in treatment choice.

In this Special Issue, we would like to focus on thyroid tumors in the elderly with the following specific topics:

• Prevalence of thyroid diseases (benign and malignant) in the elderly;
• Fine needle aspiration cytology and biomolecular markers of thyroid cancer in the elderly;
• Thyroid surgery in older patients with DTCs;
• Medical treatment of DTCs in older patients;
• Medullary cancer in the elderly;
• Anaplastic and undifferentiated thyroid carcinoma in older patients;
• New strategies of treatments in older patients with TC: target therapy and immunotherapy;
• Prognosis and risk stratification of older patients with thyroid tumors.

Dr. Giuseppe Pasqualetti
Dr. Valeria Calsolaro
Prof. Fabio Monzani
Guest Editors

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• thyroid cancer
• differentiated thyroid cancer
• elderly
• target therapy
• FNAC
• follicular carcinoma
• papillary carcinoma
• anaplastic carcinoma
• thyroid surgery