BACKGROUND: Management of small well-differentiated thyroid cancer (DTC) has generated much debate regarding the surgical approach and radioactive iodine treatment (RAI). AIM: The aim of the study was to evaluate the impact of surgical extension and RAI on the outcome of DTC ≤2 cm. METHODS: A retrospective analysis of 176 cases of DTC ≤2 cm was performed. RESULTS: At diagnosis, tumor size was 1.38 ± 0.55 cm, age 40.2 ± 13.6 years. After a mean follow-up period of 14.1 ± 4.5 years, 15.9 % patients had recurrent/persistent structural disease, with cervical neck disease (thyroid gland area and/or cervical lymph nodes) in 11.9 % cases and distant metastasis in 5.1 %. Disease specific mortality was of 1.1 %. No difference in outcome was observed between patients submitted to total or subtotal thyroidectomy. After total and subtotal thyroidectomy, the rate of recurrent/persistent structural disease was 19.1 and 10.6 % (p = 1.00), respectively. Using the multivariate cox proportion hazards analysis, no difference in the clinical outcome was observed after total or subtotal thyroidectomy (p = 0.703) neither after RAI (p = 0.807). Similar results were observed after stratification by tumor size. Multifocal disease (p = 0.007), extra-thyroid extension (p = 0.007) and presence of lymph node metastasis (p = 0.000) were associated with unfavorable outcome. CONCLUSIONS: Total thyroidectomy and RAI did not improve clinical outcomes of DTC ≤2.0 cm when compared with less extensive surgery and no RAI in selected patients. Therefore, in carefully selected patients with DTC ≤2.0 cm and no unfavorable risk factors (multifocal disease, extra-thyroid extension, lymph node and/or distant metastasis), less extensive surgery and no RAI may be acceptable treatment options.
BACKGROUND: Management of small well-differentiated thyroid cancer (DTC) has generated much debate regarding the surgical approach and radioactive iodine treatment (RAI). AIM: The aim of the study was to evaluate the impact of surgical extension and RAI on the outcome of DTC ≤2 cm. METHODS: A retrospective analysis of 176 cases of DTC ≤2 cm was performed. RESULTS: At diagnosis, tumor size was 1.38 ± 0.55 cm, age 40.2 ± 13.6 years. After a mean follow-up period of 14.1 ± 4.5 years, 15.9 % patients had recurrent/persistent structural disease, with cervical neck disease (thyroid gland area and/or cervical lymph nodes) in 11.9 % cases and distant metastasis in 5.1 %. Disease specific mortality was of 1.1 %. No difference in outcome was observed between patients submitted to total or subtotal thyroidectomy. After total and subtotal thyroidectomy, the rate of recurrent/persistent structural disease was 19.1 and 10.6 % (p = 1.00), respectively. Using the multivariate cox proportion hazards analysis, no difference in the clinical outcome was observed after total or subtotal thyroidectomy (p = 0.703) neither after RAI (p = 0.807). Similar results were observed after stratification by tumor size. Multifocal disease (p = 0.007), extra-thyroid extension (p = 0.007) and presence of lymph node metastasis (p = 0.000) were associated with unfavorable outcome. CONCLUSIONS: Total thyroidectomy and RAI did not improve clinical outcomes of DTC ≤2.0 cm when compared with less extensive surgery and no RAI in selected patients. Therefore, in carefully selected patients with DTC ≤2.0 cm and no unfavorable risk factors (multifocal disease, extra-thyroid extension, lymph node and/or distant metastasis), less extensive surgery and no RAI may be acceptable treatment options.
Authors: David S Cooper; Gerard M Doherty; Bryan R Haugen; Bryan R Hauger; Richard T Kloos; Stephanie L Lee; Susan J Mandel; Ernest L Mazzaferri; Bryan McIver; Furio Pacini; Martin Schlumberger; Steven I Sherman; David L Steward; R Michael Tuttle Journal: Thyroid Date: 2009-11 Impact factor: 6.568
Authors: Ana Luiza Maia; Laura S Ward; Gisah A Carvalho; Hans Graf; Rui M B Maciel; Léa M Zanini Maciel; Pedro W Rosário; Mario Vaisman Journal: Arq Bras Endocrinol Metabol Date: 2007-07
Authors: Nimmi Arora; Harma K Turbendian; Meredith A Kato; Tracy A Moo; Rasa Zarnegar; Thomas J Fahey Journal: Thyroid Date: 2009-05 Impact factor: 6.568
Authors: Denise P Momesso; Fernanda Vaisman; Samantha P Yang; Daniel A Bulzico; Rossana Corbo; Mario Vaisman; R Michael Tuttle Journal: J Clin Endocrinol Metab Date: 2016-03-29 Impact factor: 5.958