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CME: Differentiated thyroid cancer (DTC): therapeutic updates and optimizing treatment

Activity Description / Statement of Need:

In this online, self-learning activity:

The incidence of differentiated thyroid cancer (DTC) is on the rise over the past 10 years and roughly 57,000 new cases were reported in 2017 alone. Although the incidence of DTC has increased, the disease has a favorable prognosis with a reported 5-year survival rate of 98.2%. DTC can be categorized into two subcategories: papillary and follicular cancers. Collectively, these two thyroid cancer types account for 95% of all types of thyroid cancers. Diagnosis is typically made by palpating the central neck mass or through imaging studies, with ultrasound-guided fine-needle aspiration biopsy providing confirmation of diagnosis. However, not all cases of DTC require a biopsy, and certain types of DTC require molecular testing to properly classify the type of DTC. Patients with DTC often have genetic mutations, most notably in the MAPK and P13K/Akt/mTOR signaling pathways. The identification of these pathways has attracted considerable attention and research into the development of agents targeting them to inhibit their activity.


Target Audience:

The following healthcare professionals: medical oncologists, endocrinologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with DTC.

Commercial Support Disclosure: This program is supported by educational grants from Eisai.

This activity is free of charge

Release Date: March 15, 2019 -- Expiration Date: March 15, 2021

Faculty: Beatrice Tendler, MD


Introduction content: cursory refresher and review

  • Epidemiology and risk factors: statistics of incidence and prevalence, demographics, age, gender, genetics, race/ethnicity
  • Pathogenesis
  • Symptomology and clinical presentation: unexplained weight loss, fatigue, blurred vision
  • Palpitation, ultrasound, fine needle aspiration, biopsy
  • Biomarkers
  • Differential diagnosis
  • Staging
  • Differences in diagnostic criteria from 7th to 8th edition AJCC/TNM guidelines: defining “low-risk” patients
  • Patient case(s)

Treatment of DTC

  • Treatment overview and goals of therapy
  • Clinical trials: what is new, and how should it impact practice?
  • Thyroidectomy
  • RAI and the role of recombinant human thyrotropin / thyrotropin alfa: 
    • as alternative to thyroxine withdrawal for remnant ablation
    • adjuvant in near-total or total thyroidectomy
    • TSH suppression
  • palliative embolization
  • percutaneous ethanol injection
  • systemic therapy 
    • sorafenib
    • lenvatinib
    • investigational therapy: cabozantinib
  • Extensive / advanced disease
  • Patient case(s)

Learning Objectives

By the end of the session the participant will be able to:

  • Recognize factors affecting the diagnosis, staging, and prognosis of patients with DTC.
  • Identify present and emerging pharmacotherapeutic treatments for management of unresectable DTC and apply them to patient cases using evidence-based medicine
  • Describe how to manage challenges that arise during treatment with approved and investigational medicines for DTC, including adverse effect management, and apply** that knowledge to a patient case
  • Describe the challenges associated with DTC treatment, focusing specifically on the risks (e.g., adverse drug reactions, drug interactions, etc.) of the agents used to treat the disease, and apply that information in a patient case


This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.


Credit Designation: ScientiaCME designates this educational activity for a maximum of  0.75 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This program is approved for 0.75 hours (0.075 CEUs) of continuing education.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.  ACPE # 0574-0000-19-007-H01-P.  ACPE Accreditation effective 3/27/2019, expires 3/27/2021. This is a Knowledge (K)-type activity.

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure:

Beatriz Tendler, M.D., Associate Professor, Endocrine Neoplasia, Clinic UCONN HEALTH, has no relevant financial discloses.

Disclosures of Educational Planners: Charles Turck, PharmD has no relevant financial discloses.

Commercial Support Disclosure: This program is supported by educational grants from Eisai


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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Multiple Myeloma (MM): Highlights from the American Society for Clinical Oncology (ASCO) 2018