Thyroid cancer therapy reference (2026)

Thyroid cancer therapy in 2026 organises around histology and molecular profile.

Differentiated thyroid cancer (papillary, follicular, Hurthle cell): primary treatment is total thyroidectomy with central neck dissection in selected patients, followed by radioiodine therapy in selected risk-stratified patients. Levothyroxine TSH-suppressive therapy in many patients post-thyroidectomy. For radioiodine-refractory disease: lenvatinib and sorafenib are first-line systemic options. RET inhibitors (selpercatinib, pralsetinib) for RET fusion-positive disease. NTRK inhibitors for NTRK fusion-positive disease. BRAF V600E plus MEK combination for BRAF V600E-mutant disease.

Medullary thyroid cancer: surgery is primary treatment for localised disease. For advanced disease: RET inhibitors (selpercatinib, pralsetinib) for RET-mutant disease (most cases). Vandetanib and cabozantinib are alternatives. Emerging programs in late-stage trials.

Anaplastic thyroid cancer: this aggressive subtype has gone from a limited-options category to a structured molecular-profiling-led approach. BRAF V600E plus MEK combination (dabrafenib plus trametinib) for BRAF V600E-mutant disease (a meaningful fraction of cases). RET-targeted therapy in RET-altered disease. NTRK-targeted therapy in NTRK-fusion disease. Multimodal therapy combining surgery, radiation, chemotherapy, and targeted therapy in fit patients with appropriate molecular profile.

The diagnostic-pathway question matters. Comprehensive molecular profiling (RET, NTRK, BRAF V600E, ALK, NRAS, KRAS, others) is the gate to the targeted-therapy tier in advanced and anaplastic disease.