Is hemi-thyroidectomy adequate in low risk differentiated thyroid cancer?

Justin Benjamin, Julie Hephzibah, Anish Jacob Cherian, David Mathew, Nylla Shanthly, Regi Oommen, Justin Benjamin, Julie Hephzibah, Anish Jacob Cherian, David Mathew, Nylla Shanthly, Regi Oommen

Abstract

In low-risk differentiated thyroid carcinoma (LRDTC), appropriate surgical procedure in terms of hemi/total thyroidectomy (TT) has been an area of debate. The aim was to determine whether in LRDTC patients, hemithyroidectomy would be an adequate treatment, determine incidence of disease in contralateral lobe and evaluate the effect of radioactive iodine ablation (RAIA). Retrospective study was done from 2008 to 2014 at a single institution. Preoperative ultrasound (USG) and histopathology reports of all LRDTC patients following total/completion thyroidectomy were recorded. Details of postthyroidectomy, thyroid whole body scan, and stimulated serum thyroglobulin (sTg) levels were also documented and results analyzed. A total of 114/562 patients met inclusion criteria. Of these, 25/114 (22%) underwent hemithyroidectomy followed by a completion thyroidectomy while remaining 89/114 (78%) underwent TT initially. Preoperative USG detected single-lobe involvement in 44 patients; however, among them, histopathology revealed bilateral lobe disease in 17 (38.6%). There was a significant fall of sTg level following RAIA as compared to that before RAIA in T1b-T2 (P = 0.009 and 0.012, respectively). Median follow-up was 2 years (range: 1-7 years) with no distant metastasis or deaths recorded till 2017, except for one local recurrence 4 years after RAIA. In conclusion, the role of TT in LRDTC patients is important as 46% of patients were found to have tumor in contralateral lobe as well. Significant fall in sTg levels following RAIA justifies RAIA of remnant lobe even in LRDTC (T > 1a). It facilitates early detection of recurrence when sTg alone is used for follow-up.

Keywords: Hemithyroidectomy; low-risk differentiated thyroid carcinoma; radioactive iodine ablation; stimulated thyroglobulin.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound profile
Figure 2
Figure 2
Comparison of pre and postradioactive iodine ablation thyroglobulin in single-lobe involvement. (RAIA: Radioactive iodine ablation; Tg: Thyroglobulin [ng/ml])
Figure 3
Figure 3
Comparison of pre and postradioactive iodine ablation thyroglobulin in bilateral lobe involvement. (RAIA: Radioactive iodine ablation; Tg: Thyroglobulin [ng/ml])

References

    1. Sugino K, Kameyama K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, et al. Does completion thyroidectomy improve the outcome of patients with minimally invasive follicular carcinoma of the thyroid? Ann Surg Oncol. 2014;21:2981–6.
    1. Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: An analysis of 61,775 patients. Ann Surg. 2014;260:601–5.
    1. Gartland RM, Lubitz CC. Impact of extent of surgery on tumor recurrence and survival for papillary thyroid cancer patients. Ann Surg Oncol. 2018;25:2520–5.
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–33.
    1. Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, et al. Frequency of high-risk characteristics requiring total thyroidectomy for 1-4 cm well-differentiated thyroid cancer. Thyroid. 2016;26:820–4.
    1. Katoh R, Sasaki J, Kurihara H, Suzuki K, Iida Y, Kawaoi A, et al. Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients. Cancer. 1992;70:1585–90.
    1. Sobin LH. Histological typing of thyroid tumours. Histopathology. 1990;16:513.
    1. Roti E, degli Uberti EC, Bondanelli M, Braverman LE. Thyroid papillary microcarcinoma: A descriptive and meta-analysis study. Eur J Endocrinol. 2008;159:659–73.
    1. Oda H, Miyauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016;26:150–5.
    1. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375–81.
    1. Schlumberger M, Sherman SI. Approach to the patient with advanced differentiated thyroid cancer. Eur J Endocrinol. 2012;166:5–11.
    1. Macedo FI, Mittal VK. Total thyroidectomy versus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: A meta-analysis. Surg Oncol. 2015;24:117–22.
    1. Kuba S, Yamanouchi K, Hayashida N, Maeda S, Adachi T, Sakimura C, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study. Int J Surg. 2017;38:143–8.
    1. Ritter A, Bachar G, Hirsch D, Benbassat C, Katz O, Kochen N, et al. Natural history of contralateral nodules after lobectomy in patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2018;103:407–14.
    1. Shrime MG, Goldstein DP, Seaberg RM, Sawka AM, Rotstein L, Freeman JL, et al. Cost-effective management of low-risk papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2007;133:1245–53.
    1. Hilly O, Stern-Shavit S, Iran S, Feinmesser R. Treatment decisions and adherence to guidelines in the treatment of low risk papillary carcinoma of the thyroid. Isr Med Assoc J. 2014;16:548–52.
    1. Ito Y, Masuoka H, Fukushima M, Inoue H, Kihara M, Tomoda C, et al. Excellent prognosis of patients with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy. World J Surg. 2010;34:1285–90.

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