Abstract

This commentary delves into the significance of molecular markers, specifically BRAF and TERT mutations, in refining risk stratification and management strategies for thyroid cancer, with a focus on optimizing radioactive iodine (RAI) doses. BRAFV600E mutation notably impacts risk classification in papillary thyroid cancer (PTC), elevating it to intermediate-risk status and affecting recurrence rates. Additionally, the inclusion of TERT promoter mutation in risk assessment categorizes PTC larger than 1cm as high-risk. The initial maximum permissible RAI dose, tailored to the respective risk group, targets heterogeneous tumor cell populations, including those with poor RAI uptake due to mutations, by utilizing the cross-fire effect of radiation, thereby reducing the risk of recurrence. BRAF mutational analysis aids in ruling out follicular neoplasms, while TERT mutational analysis facilitates tailored management, particularly in follicular tumors of uncertain malignant potential (FT-UMP). Although current guidelines don't advocate RAI dose modification based solely on molecular markers, ongoing research emphasizes the need for exploration. Proactive integration of BRAF and TERT mutational analysis pre-RAI therapy enhances risk stratification, facilitating personalized treatment decisions. It's recommended to conduct mutational analysis for BRAF and TERT genes before initiating RAI therapy in PTC and RAS+TERT in FTC for improved risk assessment and tailored RAI administration. As molecular insights advance, personalized approaches are vital for optimizing patient outcomes in thyroid cancer management

Key words: TERT, BRAFV600E, Molecular, Thyroid Cancer, Risk