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Lobectomy safe, reliable for low-risk papillary thyroid carcinoma

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January 10, 2018

Researchers in Israel reported that lobectomy was a safe and reliable first-line treatment for patients with contralateral non-suspicious thyroid nodules and small, low-risk papillary thyroid carcinoma.

“Recent trends in the management of thyroid cancer call into question the need for routine total thyroidectomy in patients with low-risk PTC [papillary thyroid carcinoma] who have a non-suspicious or cytologically benign contralateral nodule,” Amit Ritter, MD, of the Sackler Faculty of Medicine at Tel Aviv University, and colleagues wrote. “The decrease in use of [radioiodine] ablation in low-risk PTC patients enables lobectomy in larger numbers of patients. ... The goal of this less aggressive approach is to decrease surgical risks (for hypoparathyroidism and vocal cord palsy), reduce the need for lifelong thyroid hormone replacement and reduce the psychological and financial burden of the disease.”

The researchers studied 112 patients with at least one solid nodule 3 mm or larger with benign cytology in the contralateral lobe, or at least one small non-suspicious nodule per ultrasound. The patients’ median age was 57 years, and median carcinoma size was 8 mm at the time of initial lobectomy. The median size on the contralateral side was 7 mm.

The median growth was zero after a median follow-up of 6 years, Ritter and colleagues reported (range, -20 mm to 19 mm). Nearly one-fourth of nodules (n = 26; 23%) grew in size by 3 mm or more (median, 6 mm), and nearly one-fifth developed new nodules (n = 20; 18%).

Eleven percent of patients (n = 12) received a complete thyroidectomy, with three patients undergoing surgery for growth, seven for Bethesda category III to V and one each for unknown reasons and malignancy, the researchers wrote.

Five percent of patients were diagnosed with contralateral papillary thyroid carcinoma based on complete thyroidectomy specimens (n = 6), according to Ritter and colleagues. All patients were disease-free by the end of the follow-up period.

“For the low-risk patients with small PTC tumors and contralateral non-suspicious thyroid nodules, lobectomy alone is a safe option, provided that a regular ultrasound follow-up is available to detect the small proportion of patients who may need completion thyroidectomy,” the researchers wrote. – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.