In a statement issued by the American Thyroid Association, members of its Surgical Affairs Committee said enhanced communication and well-defined interdisciplinary care plans for patients undergoing thyroidectomy are necessary.
Sally E. Carty, MD, of the division of endocrine surgery at the University of Pittsburgh School of Medicine, and colleagues based their recommendations on findings from the 2009 ATA guidelines, besides reviewing office notes, referral letters, operative consents, operative reports, operative diagrams and artwork, and preoperative and postoperative patient education materials.
They identified essential elements of interdisciplinary communication from three distinct settings: preoperative evaluations, intraoperative findings and postoperative data, events and plans.
“A wide variety of findings from clinical examination, biochemical testing, cross-sectional and functional imaging tests, and other sources can have a major impact on postoperative risk assessment and therefore may significantly influence decision-making with regard to the role of adjuvant radioiodine ablation therapy, degree of thyrotropin suppression, and extent an frequency of follow-up evaluations,” the committee members wrote.
High-risk physical examination findings and historical features such as palpable cervical lymph node or prior neck irradiation may influence postoperative management and, therefore, should be included in preoperative evaluation, they said.
Several intraoperative details are similarly critical to the risk-stratified postoperative management, including the extent of thyroid surgery, description of gross extrathyroidal extension, completeness of surgical resection and more.
Additionally, postoperative findings such as hypocalcemia, hypothyroidism and vitamin D use are factors that may affect postoperative care.
“Although defining the roles and responsibilities of thyroid cancer care is beyond the scope of the present article, we feel sure all caregivers would agree that careful communication among the individual practitioners of a health-care environment remains of paramount importance — it is then that all practitioners and the patients themselves most benefit,” the researchers concluded.
Disclosure: William B. Inabnet, III, MD, and R. Michael Tuttle, MD, report they are consultants for Genzyme. No additional relevant financial disclosures were reported.