Optimization of the risk-benefit ratio of differentiated thyroid cancer treatment

Postoperative complications and long-term outcomes after total and subtotal thyroidectomy: a retrospective study

The choice between total thyroidectomy (TT) and subtotal thyroidectomy (STT) can affect postoperative complications and long-term outcomes in these patients. This study aimed to investigate postoperative complications and long-term outcomes in patients who underwent TT and STT. This retrospective study investigated 1.022 patients who admitted to Ghaem and Razavi hospitals, Mashhad, and underwent thyroidectomy between 2011 and 2017. Data related to postoperative complications, recurrence rate and overall survival were collected and analyzed. The data collection tool used in this research was a checklist. In this study, women accounted for 863 and men for 159 of the total population. The highest number of thyroidectomy surgeries was found in 2013 and in all years the majority of thyroidectomy surgeries were performed on women. The results demonstrated that 71.2% of the patients underwent TT and 28.8% underwent STT. The percentage rate of recurrent laryngeal nerve injury after thyroidectomy surgery (regardless of the type of selected surgery) was 6.1%, affecting 62 individuals. No significant relationship was observed between the type of selected surgery and damage to this nerve (P > 0.05). In addition, a statistically significant correlation was reported between thyroidectomy and suffering from hypocalcemia (P < 0.05). The study revealed that TT was associated with a higher postoperative complication rate compared to STT. Individual treatment plans must be developed based on the risks and benefits of each surgical approach.

AGGRESSIVE COURSE OF DIFFERENTIATED THYROID GLAND CANCER IN A PATIENT WITH INSULIN RESISTANCE: CASE ANALYSIS FROM PRACTICE

Differentiated thyroid cancer (DTC) is usually characterized by a harmless clinical behavior but in some cases it can manifest itself as a metastatic damage to the bone system. The authors reported case from their practice of an aggressive DTC course in a patient with insulin resistance, accompanied by the development of metastases in the bone system. The main goals of the patient's treatment at each stage of radioiodine therapy were to reduce the foci of metastatic bone damage in terms of their number and volume as well as insulin resistance as a risk factor affecting insulin-like growth factors. A clinical case analysis found that radioiodine therapy might be useful for disease control in cases with potentially aggressive variants of DTC. This category of patients requires careful monitoring of insulin resistance, insulin-like growth factors and appropriate antitumor treatment.

Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival

We are witnessing a rapid worldwide increase in the incidence of papillary thyroid carcinoma (PTC) in the last thirty years. Extensive implementation of cancer screening and wide availability of neck ultrasound or other imaging studies is the main reason responsible for this phenomenon. It resulted in a detection of a growing number of clinically asymptomatic PTCs, mainly low-risk tumors, without any beneficial impact on survival. An indolent nature of low-risk PTC, particularly papillary thyroid microcarcinoma (PTMC), and the excellent outcomes raise an ongoing discussion regarding the adequacy of treatment applied. The question of whether PTMC is overtreated or not is currently completed by another, whether PTMC requires any treatment. Current ATA guidelines propose less extensive preoperative diagnostics and, if differentiated thyroid cancer is diagnosed, less aggressive surgical approach and limit indications for postoperative radioiodine therapy. However, in intrathyroidal PTMCs in the absence of lymph node or distant metastases, active surveillance may constitute alternative management with a low progression rate of 1%-5% and without any increase in the risk of poorer outcomes related to delayed surgery in patients, in whom it was necessary. This review summarizes the current knowledge and future perspectives of active surveillance in low-risk PTC.

The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

BACKGROUND

After partial resection of the thyroid gland, a second operation referred to as "completion thyroidectomy" may be required if histopathological analysis indicates the presence of differentiated thyroid cancer (DTC). Although there is little evidence, it is assumed that the time point of completion thyroidectomy is not critical for oncological prognosis of patients with DTC. We assessed whether patients with total thyroidectomy (TTx) in a two-step procedure have an equal long-term prognosis with regard to disease-specific survival (DSS) compared to patients immediately undergoing total thyroidectomy in a one-step procedure.

METHODS

A database study using the Würzburg thyroid cancer database with 2258 patients with pT1a-pT4b tumours DTC who were operated between 1980 and 2016 was carried out.

RESULTS

A total of 277 patients with papillary microcarcinoma pT1aN0M0 were treated by hemithyroidectomy. TTx as one-step procedure was performed in 1114 patients compared to 867 with TTx as a two-step procedure. Patients with papillary thyroid cancer more frequently had a TTx as one-step procedure than follicular thyroid cancer patients (59.4% vs 47%; P < 0.001). Compared to a one-step thyroidectomy, overall complication rate was not different compared to patients undergoing a single operation. Multivariate analysis showed that the presence of distant metastases, T-stage and age at diagnosis were the only independent determinants for DTC-specific survival, regardless of a one- or two-time thyroidectomy.

CONCLUSION

The present study on the largest of such patient collectives provides evidence that a delayed completion operation does not affect DSS in DTC, nor does it lead to a significant increase in complication rates.