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Management before thyroidectomy may lead to complications in patients
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Adults who undergo thyroidectomy in France often receive suboptimal management before the procedure, and this may account for overdiagnosis and potential harms to patients, according to findings published in BMJ Open.
Anne Fagot-Campagna, MD, PhD, of the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés in Paris, and colleagues evaluated data from the Sniiram (French National Health Insurance Information System) database on 35,367 adults (mean age, 51 years; 80% women) who underwent thyroid surgery in 2010 to determine the pathway of care the patients received and to detect potential harms.
Most participants were diagnosed with multiple nodules or goiter (38%), followed by benign nodules (20%) and thyroid cancer (17%); a different type of diagnosis was made in 25% of participants. About 89% of participants with a postoperative diagnosis of thyroid cancer and 86% of participants with multiple nodules or goiters had a total thyroidectomy or completion thyroidectomy performed; 71% of participants with benign nodules had a partial thyroidectomy. The rate was 5.3 per 10,000 people for thyroidectomy with a diagnosis of thyroid cancer, nodule or goiter in 2010.
In the year before surgery, fine-needle aspiration was performed in 39% of participants with thyroidectomy and a diagnosis of cancer or benign nodule. Among all participants, 90% had thyroid-stimulating hormone assays performed, more than 63% had a thyroxine assay, more than 35% had a triiodothyronine assay and more than 18% had thyroid scintigraphy. Referral to an endocrinologist was made for fewer than half the participants regardless of their diagnosis.
In the 12 months after surgery, thyroid hormone replacement therapy was administered to all participants who underwent thyroidectomy and 44% with a partial thyroidectomy and diagnosis of a benign nodule. Referral to an endocrinologist was low, with 56% of participants with thyroid cancer and 34% of participants with benign nodules being referred.
Rates of late complications varied from 17% to 23%, and rates for recurrent laryngeal nerve injury varied from 2.3% to 1.2%. More participants diagnosed with thyroid cancer also had hypoparathyroidism (5.7%) compared with those with benign nodules (1%).
“With more than 35,400 general scheme beneficiaries (or about 45,800 nationwide) who underwent surgery in 2010, and 35,300 in 2013, thyroidectomy is one of the surgical procedures most commonly performed in France,” the researchers wrote. “The thyroidectomy rate with a diagnosis of benign nodules appears to be excessively high compared with the thyroidectomy rate with a diagnosis of thyroid cancer. Such assessment is likely to be shared by many European countries. Partial compliance with guidelines prior to thyroidectomy, especially the low rate of fine-needle aspiration cytology, indicates the need for large-scale diffusion of current guidelines and clinical practice evaluation by all professionals involved in the care pathway.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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