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PTC recurrence similar after hemithyroidectomy, thyroidectomy
Researchers observed no substantial difference in papillary thyroid carcinoma recurrence rate over 7 years of follow-up between adults who underwent hemithyroidectomy and those who had thyroidectomy, according to findings from Korea.
Hoon Sung Choi, MD, PhD, of the department of internal medicine, Kangwon National University Hospital in South Korea, and colleagues evaluated 147 adults (mean age, 44 years) with 1 cm to 4 cm papillary thyroid carcinoma (PTC) who underwent hemithyroidectomy between 2004 and 2008 and compared them with 298 adults (mean age, 45 years) who underwent thyroidectomy to determine the recurrence rate among the two groups. Follow-up was a median 7 years.
Overall, the recurrence rates were 6.1% in the hemithyroidectomy group compared with 5.7% in the thyroidectomy group, revealing no statistically significant difference between the two groups. Similarly, the was no significant difference between the two groups for recurrence-free survival.
Nine participants in the hemithyroidectomy group experienced recurrence, and eight developed the recurrence in their remnant contralateral thyroid lobes and five in the cervical lymph nodes. Seventeen participants in the thyroidectomy group experienced recurrence, with 15 developing the recurrence in their cervical lymph nodes, one in the operated thyroid bed and one in the lung.
The risk for recurrence was higher in the hemithyroidectomy group compared with the thyroidectomy group (HR = 6.39; 95% CI, 1.24-33.01) in all participants with contralateral nodules observed in preoperative evaluation. No difference between the two groups existed for recurrence-free survival when contralateral nodules were not present.
“Although the new [American Thyroid Association] guideline has widened the group of patients who are candidates for hemithyroidectomy, the proper surgical extent for PTC of 1 cm to 4 cm has been debated,” the researchers wrote. “Our data demonstrated that [recurrence-free survival] did not differ in patients with PTC of 1 cm to 4 cm who underwent hemithyroidectomy compared to patients with matched baseline characteristics who underwent thyroidectomy, supporting the new ATA guideline.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Recurrence is probably the most relevant outcome in patients with PTC and that by which current ATA guidelines stratify risk (Haugen BR, et al. Thyroid. 2016;doi:10.1089/thy.2015.0020). The results of Kim and colleagues validate practice patterns of many endocrine surgeons who offer total thyroidectomy for patients with indeterminate nodules when contralateral nodules are present. They also validate current ATA guidelines that challenge the practice of recommending total thyroidectomy for all patients with PTCs 1 cm or greater. Similar recurrence and fewer complications certainly favor lobectomy, but several other considerations should guide decisions about the extent of surgery. The remaining lobe often fails to provide enough hormone for patients to avoid daily supplementation, especially if clinicians aim to suppress TSH. Additionally, thyroglobulin may be a less reliable tumor marker in patients with a remaining lobe, so the accessibility of quality ultrasound surveillance should be considered. Radioactive iodine offers valuable staging information and can treat occult metastatic disease, but not if a lobe remains. While less extensive surgery is fast becoming an acceptable and attractive option for low-risk PTC, it remains important for clinicians to tailor treatment decisions to an individual’s risk tolerance after a thorough discussion of all considerations.