Recurrence-free survival after total thyroidectomy and lobectomy in patients with papillary thyroid microcarcinoma

Objective Papillary thyroid microcarcinoma (PTMC) accounts for most of the increase in thyroid cancer in recent decades. We compared clinical outcomes and surgical complications of lobectomy and total thyroidectomy (TT) in PTMC patients. Design and methods In this retrospective individual risk factor-matched cohort study, 2031 patients with PTMC were initially included. Patients who underwent lobectomy or TT were one-to-one matched according to individual risk factors, including age, sex, primary tumor size, extrathyroidal extension, multifocality and cervical lymph node (LN) metastasis. Results In total, 688 patients were assigned to each group. During the median 8.5 years of follow-up, 26 patients (3.8%) in the lobectomy group and 11 patients (1.6%) in the TT group had recurrences. The relative risk of recurrence was significantly less in the TT than that in the lobectomy group (hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.21–0.81; P = 0.01). Most recurrences (84.6%) in the lobectomy group occurred in the contralateral lobe, and all patients were disease-free after completion of thyroidectomy. There were no significant differences in recurrence-free survival between the two groups after exclusion of contralateral lobe recurrences (HR, 2.75; 95% CI, 0.08–8.79; P = 0.08). There were significantly more patients with transient and permanent hypoparathyroidism in the TT than that in the lobectomy group (P < 0.001). Conclusions Lobectomy could be appropriate for most patients with PTMC when there is no evidence of extrathyroidal disease in the preoperative work-up. Preoperative and postoperative imaging studies are important for patients who undergo lobectomy for PTMC, because most recurrences are in the contralateral lobe.

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Unusual case of radioactive iodine induced Graves disease with orbitopathy following total thyroidectomy in a patient with papillary thyroid microcarcinoma

Endokrynologia Polska ◽

10.5603/ep.a2020.0019 ◽

2020 ◽

Author(s):

Kajetan Zgubieński ◽

Agnieszka Walczyk ◽

Aldona Kowalska

Keyword(s):

Total Thyroidectomy ◽

Unusual Case ◽

Radioactive Iodine ◽

Papillary Thyroid Microcarcinoma ◽

Graves Disease ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma

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Partial Thyroidectomy for Papillary Thyroid Microcarcinoma: Is Completion Total Thyroidectomy Indicated?

World Journal of Surgery ◽

10.1007/s00268-015-3327-7 ◽

2015 ◽

Vol 40 (3) ◽

pp. 510-515 ◽

Cited By ~ 14

Author(s):

G. Donatini ◽

M. Castagnet ◽

T. Desurmont ◽

N. Rudolph ◽

D. Othman ◽

...

Keyword(s):

Total Thyroidectomy ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

Partial Thyroidectomy

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Multifocal papillary thyroid microcarcinoma in the end stage of Hashimoto’s thyroiditis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh171114210k ◽

2018 ◽

Vol 146 (11-12) ◽

pp. 672-676

Author(s):

Bozidar Kovacevic ◽

Snezana Kuzmic-Jankovic ◽

Bosko Milev ◽

Vesna Skuletic

Keyword(s):

Total Thyroidectomy ◽

Thyroid Tissue ◽

Thyroid Volume ◽

Final Diagnosis ◽

Surrounding Tissue ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Disease Evolution ◽

Thyroid Microcarcinoma ◽

End Stage

Introduction. Frequent coexistence of papillary thyroid carcinoma (PTC) and Hashimoto?s thyroiditis (HT) indicates their immunological connection, with no consensus on the cause and effect of this relationship. The aim of this report is to present an unusual case of occurrence of multifocal papillary thyroid microcarcinoma in severe thyroid atrophy as a result of the end stage of HT and to analyze its clinical significance. Case outline. A 59-year-old female patient with a 14-year-long history of HT was admitted for the surgical treatment of a cytologically suspected PTC. During disease evolution, ultrasound controls were performed once a year and the findings showed a progressive decrease in thyroid volume. The nodule in the right lobe was detected for the first time in 2014. After a one-year follow-up, the nodule size was 7 mm. Fine needle aspiration biopsy was performed and was reported as ?suspicious for PTC.? The patient underwent total thyroidectomy. Intraoperatively, thyroid gland was indistinguishable from the surrounding tissue and histopathological intraoperative consultation was performed in order to confirm malignancy and thyroid tissue. After gross examination, all surgical specimens weighed less than 3 g. A final diagnosis of multifocal papillary thyroid microcarcinoma with bilateral presentation and extrathyroidal extension was made. Seventeen months after total thyroidectomy was performed, the patient was well, with no evidence of metastasis or recurrence of papillary carcinoma. Conclusion. In the circumstances of severe thyroid atrophy, papillary microcarcinoma with infiltrative growth can lead to early extrathyroid extension, and even to the infiltration of surrounding structures.

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Predictors Associated with the Maintenance of Normal Thyroid Function after Unilateral Total Thyroidectomy in Patients with Papillary Thyroid Microcarcinoma

Journal of Endocrine Surgery ◽

10.16956/jes.2019.19.3.51 ◽

2019 ◽

Vol 19 (3) ◽

pp. 51

Author(s):

Jihyeong Kim ◽

Ha Kyoung Park ◽

Taekwun Ha

Keyword(s):

Total Thyroidectomy ◽

Thyroid Function ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Normal Thyroid ◽

Thyroid Microcarcinoma ◽

Normal Thyroid Function

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Papillary thyroid microcarcinoma: Analysis of outcomes and features predicting risk of recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18569 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18569-e18569

Author(s):

Chandra Shekhar Dravid ◽

Priya Sr ◽

P. S. Pai ◽

D. Chaukar

Keyword(s):

Risk Factors ◽

High Risk ◽

Adverse Events ◽

Univariate Analysis ◽

Distant Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Free Survival ◽

Thyroid Microcarcinoma ◽

Radioiodine Ablation

e18569 Background: Papillary thyroid microcarcinoma (PTMC) is an enigmatic entity - diverse opinions exist on its clinical course and management. We aimed to analyse disease outcomes and to identify high-risk factors in PTMCs. Methods: This is a retrospective analysis of patients of PTMC treated in our hospital between 2000 and 2014. Clinico-radiological features, treatment details, long term outcomes and recurrence patterns were noted; these were analysed statistically. Results: 160 patients were studied; 61% were females; 86% were aged 55 years or below; 95% cases presented with an enlarged neck node or thyroid nodule or distant metastasis while 5% were incidentalomas. Total thyroidectomy with radioiodine ablation was done in 77% while hemithyroidectomy was done in 23% patients. Follow up ranged between 2 and 238 months. There were 11 (7%) disease related events (nodal or distant metastases or death due to persistent disease). 4 (2.5%) patients died of disease. On univariate analysis, a larger thyroid primary (p 0.001), pre-operatively radiologically identifiable disease in the thyroid (p 0.02) and the lesion not being an incidentaloma (p 0.01) were associated with development of adverse events. Multivariate analysis confirmed the latter two factors as high risk (p 0.05 and 0.00). Nodal metastasis increased with a larger primary (p 0.001), which was multifocal (p 0.00), bilateral (p 0.01) and showed extrathyroid extension (p 0.00). Distant metastases were related with advanced age (p 0.02), presence of involved nodes (p 0.04), larger primary tumour (p 0.15), multifocal tumour (p 0.17), bilateral foci (p 0.02) and extrathyroidal extension (p 0.06). Correspondingly, Kaplan Meier curves showed a better overall survival (OS) and disease free survival (DFS) with incidentalomas as compared to cases presenting with symptoms (Median OS 84 months vs 78 months; Median DFS 79 months vs 77 months) and cases where the lesion was not seen on radiology (Median OS 80 months vs 76 months; Median DFS 80 months vs 75 months). However neither was significant statistically. Addition of Radioiodine ablation did not confer survival advantage (p 0.6). Conclusions: PTMCs are associated with adverse events despite the size of the primary lesion. Stratification as per the above risk factors can improve event free survival. Conversely, aggressive treatment may be deferred in cases of lesions discovered incidentally or on routine screening.

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