Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;104(2):113-116.
doi: 10.1308/rcsann.2021.0058.

Thyroid lobectomy for low-risk thyroid cancers

B Puttergill  1 , S Khan  1 , I Christakis  2 , R Dumbill  3 , A Mclaren  3 , G Sadler  1 , R Mihai  1
Affiliations

Thyroid lobectomy for low-risk thyroid cancers

B Puttergill et al. Ann R Coll Surg Engl. 2022 Feb.

Abstract

Background: The 2016 American Thyroid Association (ATA) guidelines proposed thyroid lobectomy for low-risk differentiated thyroid cancer (DTC); however, this approach is yet to be widely adopted. The aim of the study was to review our practice over three years following the publication of these guidelines identifying patients who underwent lobectomy-only for low-risk DTC in two regional units in the same multidisciplinary team (MDT).

Method: A retrospective review of patients who were operated between January 2016 and December 2018 was carried out.

Results: In total, 288 patients undergoing thyroid surgery were included. The preoperative distribution of cytology was: Thy 1 or 2 in 46, THY3a in 57, THY3f in 154, THY4 in 18 and THY5 in 13 patients. Median size of nodules was 26mm (range 1-70mm). DTC was diagnosed in 95 patients (33%). Overall, 39% (n = 37) of patients underwent completion thyroidectomy according to ATA recommendations on size or adverse histological features. The only variable associated with likelihood of completion was tumour size (p < 0.05, OR 1.14). Ten patients were discharged following surgery with no further follow-up as they had T1a/b well-differentiated DTC with no high-risk histological features.

Conclusion: Lobectomy-only appears to be the current surgical practice in two-thirds of patients presenting to our regional units with differentiated thyroid carcinoma. In the context of the current drive to reduce the extent of treatment for low-risk thyroid cancer, there is a need for a more homogeneous approach to these patients and for protocols for long-term follow-up after lobectomy-only.

Keywords: Risk; Thyroid cancer; Thyroid gland; Thyroid neoplasms; Thyroidectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Diagnostic cytology of 288 patients undergoing lobectomy from January 2016 to December 2018 in two regional centres in the UK
Figure 2
Figure 2
Patient schema for 328 patients undergoing thyroid surgery for thyroid nodules. PTC, papillary thyroid carcinoma; FTC, follicular thyroid carcinoma; MTC, medullary thyroid carcinoma.
Figure 3
Figure 3
Comparison of size of differentiated thyroid carcinoma from patients undergoing surgery. *Significant difference (p < 0.01), t-test and by univariate logistic regression.
See this image and copyright information in PMC

References

    1. Chadwick D, Surgeons T, Kinsman R. The British Association of Endocrine & Thyroid Surgeons fifth national audit report. 2017. https://www.baets.org.uk/wp-content/uploads/BAETS-Audit-National-Report-...
    1. Haugen BR, Alexander EK, Bible KCet 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: 1–133. 10.1089/thy.2015.0020 - DOI - PMC - PubMed
    1. Tuttle M, Morris LF, Haugen Bet al. AJCC cancer staging manual. In: Amin MB, Edge SB, Greene F. et al. Thyroid Differentiated and Anaplastic Carcinoma. 8th edn. New York: Springer; 2017.
    1. Mihai R, Parker A, Roskell D SG. One in four patients with follicular thyroid cytology (THY3) Has a thyroid carcinoma. Thyroid 2008; 19: 33–37. 10.1089/thy.2008.0200 - DOI - PubMed
    1. Sena G, Gallo G, Innaro Net al. Total thyroidectomy vs completion thyroidectomy for thyroid nodules with indeterminate cytology/follicular proliferation: a single-centre experience. BMC Surg 2019; 19: 87. 10.1186/s12893-019-0552-2 - DOI - PMC - PubMed