CHICAGO — Douglas S. Ross, MD, co-director of Thyroid Associates at Massachusetts General Hospital, received the 2019 Paul Starr Award during the Annual Meeting of the American Thyroid Association.
The award recognizes Ross as an outstanding contributor to clinical thyroidology.
“It has been a privilege to work with Dr. Ross,” Gilbert H. Daniels, MD, co-director of Thyroid Associates at Massachusetts General Hospital, said during a presentation. “His seminal paper on multifocal papillary microcarcinoma refuted the dogma that radioactive iodine was necessary for all patients with multifocal papillary microcarcinoma.”
The theme of Ross’s talk focused on the ever-changing treatment paradigm for low-risk papillary thyroid cancer.
“Back in 1987, lobectomies were mostly performed for intrathyroidal papillary carcinoma,” Ross said. “During this time, it was suggested that this population of patients could be successfully treated with conservative surgery, but we later stopped performing lobectomies in this population and began using radioactive iodine, only to go back to performing lobectomies because data showed radioactive iodine was associated with significant risk for secondary malignancies.”
Much has been gained from stopping use of radioactive iodine in low-risk patients, including reductions in secondary malignancies and complication rates, Ross said.
“Despite the 2015 ATA guideline that stated that routine radioactive iodine ablation in lieu of completion thyroidectomy is not recommended, data from the National Cancer Database showed that 24% of 32,119 low-risk patients received radioactive iodine after lobectomy. This clearly goes against the ATA guidelines and against using common sense when treating these patients.”
Surveillance after lobectomy in low-risk patients presents a significant challenge.
“Neck ultrasound is commonly used as post-operative surveillance after lobectomy,” Ross said. “Although the technique has high sensitivity, neck ultrasound is associated with moderate specificity and there is the potential for significant overuse, which also comes at increased financial costs.”
Additionally, lobectomy does not obviate the need for postoperative thyroid hormone therapy for most low-risk patients.
“Perhaps we can use gene expression to predict risk in patients with low-risk papillary thyroid cancer,” Ross said. “However, the question then becomes will this type of surveillance approach ever become affordable?” – by Jennifer Southall
Ross DS, et al. Paul Starr Award Lecture. Presented at: Annual Meeting of the American Thyroid Association; Oct. 30-Nov. 3, 2019; Chicago.
Disclosures: Ross reports no relevant financial disclosures.