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Application of the new American Thyroid Association guidelines leads to a substantial rate of completion total thyroidectomy to enable adjuvant radioactive iodine.
Surgery. 2017 01; 161(1):127-133.S

Abstract

BACKGROUND

The recently published 2015 American Thyroid Association guidelines recognize lobectomy as a viable alternative for low-risk cancers and advise more conservative use of radioactive iodine. Some factors indicating adjuvant treatment with radioactive iodine (and therefore completion total thyroidectomy), however, only can be found upon pathologic investigation.

METHODS

We performed a retrospective analysis including patients with American Thyroid Association low- and low-to-intermediate risk well-differentiated thyroid cancer 1-4 cm. We evaluated how often radioactive iodine would be indicated and compared this with our historic rate. A subanalysis was performed to determine the rate of completion total thyroidectomy necessary, based on the indications for adjuvant radioactive iodine therapy.

RESULTS

A total of 394/1,000 (39.4%) patients were included for final analysis. Adjuvant radioactive iodine would have been favored in 101/394 (25.6%) of patients, which is 2.5 times less than was given in our historic cohort. Completion total thyroidectomy to enable adjuvant radioactive iodine would have been recommended in 29/149 (19.5%) patients preoperatively eligible for lobectomy.

CONCLUSION

Despite the tightened regulations for radioactive iodine, about 20% of patients with apparently "low-risk" well-differentiated thyroid cancer who are eligible for lobectomy may need completion total thyroidectomy because of pathologic findings for which radioactive iodine use is listed as considered or favored by the current guidelines.

Authors+Show Affiliations

Department of Surgery, University California San Francisco, San Francisco, CA; Department of Oncological and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Surgery, University of Toronto, Toronto, Canada.Department of Surgery, University California San Francisco, San Francisco, CA.Department of Surgery, University California San Francisco, San Francisco, CA.Department of Surgery, University California San Francisco, San Francisco, CA.Department of Surgery, University California San Francisco, San Francisco, CA.Department of Surgery, University California San Francisco, San Francisco, CA.Division of Endocrinology and Metabolism, University California San Francisco, San Francisco, CA.Department of Surgery, University California San Francisco, San Francisco, CA. Electronic address: Quan-Yang.Duh@ucsf.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27855968

Citation

Kluijfhout, Wouter P., et al. "Application of the New American Thyroid Association Guidelines Leads to a Substantial Rate of Completion Total Thyroidectomy to Enable Adjuvant Radioactive Iodine." Surgery, vol. 161, no. 1, 2017, pp. 127-133.
Kluijfhout WP, Pasternak JD, Drake FT, et al. Application of the new American Thyroid Association guidelines leads to a substantial rate of completion total thyroidectomy to enable adjuvant radioactive iodine. Surgery. 2017;161(1):127-133.
Kluijfhout, W. P., Pasternak, J. D., Drake, F. T., Beninato, T., Shen, W. T., Gosnell, J. E., Suh, I., C, L., & Duh, Q. Y. (2017). Application of the new American Thyroid Association guidelines leads to a substantial rate of completion total thyroidectomy to enable adjuvant radioactive iodine. Surgery, 161(1), 127-133. https://doi.org/10.1016/j.surg.2016.05.056
Kluijfhout WP, et al. Application of the New American Thyroid Association Guidelines Leads to a Substantial Rate of Completion Total Thyroidectomy to Enable Adjuvant Radioactive Iodine. Surgery. 2017;161(1):127-133. PubMed PMID: 27855968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Application of the new American Thyroid Association guidelines leads to a substantial rate of completion total thyroidectomy to enable adjuvant radioactive iodine. AU - Kluijfhout,Wouter P, AU - Pasternak,Jesse D, AU - Drake,Frederick T, AU - Beninato,Toni, AU - Shen,Wen T, AU - Gosnell,Jessica E, AU - Suh,Insoo, AU - C,Liu, AU - Duh,Quan-Yang, Y1 - 2016/11/14/ PY - 2016/02/16/received PY - 2016/04/14/revised PY - 2016/05/13/accepted PY - 2016/11/20/pubmed PY - 2017/7/20/medline PY - 2016/11/19/entrez SP - 127 EP - 133 JF - Surgery JO - Surgery VL - 161 IS - 1 N2 - BACKGROUND: The recently published 2015 American Thyroid Association guidelines recognize lobectomy as a viable alternative for low-risk cancers and advise more conservative use of radioactive iodine. Some factors indicating adjuvant treatment with radioactive iodine (and therefore completion total thyroidectomy), however, only can be found upon pathologic investigation. METHODS: We performed a retrospective analysis including patients with American Thyroid Association low- and low-to-intermediate risk well-differentiated thyroid cancer 1-4 cm. We evaluated how often radioactive iodine would be indicated and compared this with our historic rate. A subanalysis was performed to determine the rate of completion total thyroidectomy necessary, based on the indications for adjuvant radioactive iodine therapy. RESULTS: A total of 394/1,000 (39.4%) patients were included for final analysis. Adjuvant radioactive iodine would have been favored in 101/394 (25.6%) of patients, which is 2.5 times less than was given in our historic cohort. Completion total thyroidectomy to enable adjuvant radioactive iodine would have been recommended in 29/149 (19.5%) patients preoperatively eligible for lobectomy. CONCLUSION: Despite the tightened regulations for radioactive iodine, about 20% of patients with apparently "low-risk" well-differentiated thyroid cancer who are eligible for lobectomy may need completion total thyroidectomy because of pathologic findings for which radioactive iodine use is listed as considered or favored by the current guidelines. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/27855968/Application_of_the_new_American_Thyroid_Association_guidelines_leads_to_a_substantial_rate_of_completion_total_thyroidectomy_to_enable_adjuvant_radioactive_iodine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(16)30587-6 DB - PRIME DP - Unbound Medicine ER -