Role and Associated Disparities in the Utilization of Radioiodine Therapy and Total Thyroidectomy in Patients with Low-Risk Thyroid Cancer

Background: Low risk thyroid cancer can be treated with lobectomy or total thyroidectomy. Studies have shown that the risk of recurrence does not differ between the two surgeries, although there are higher rates of complications with total thyroidectomy. Our study aimed to find if there were differences in quality of life and thyroid function in the two treatments. Methods: Low risk DTC survivors answered three QoL questionnaires (EQ5D3L, SF36, and EORTC QLQ C30) and had their thyroid function evaluated. Results: Twenty-six lobectomy patients and 101 total thyroidectomy were included. Hypoparathyroidism occurred more in the total thyroidectomy, and TSH was more likely to be on target (0.5-2.0) in lobectomy. There was no difference between groups regarding QoL, but there was a significant difference regarding thyroid function. In SF36 form, TSH off target led to more physical limitations, pain, less vitality, and worse social aspects. Abnormal total T3 level was associated with pain, less vitality, and worse mental health. In the EORTC QLQ C30, off target TSH led to worse role functioning, fatigue, and nausea. EQ5D form showed that worse utility index was found when TT3 was not in normal range. Conclusion: This study showed there was a difference among thyroid function, specially TSH depending on type of surgery. When uncontrolled, TSH was associated with worse aspects of the quality of life. Therefore, lobectomy patients have a better thyroid function control and less surgical complications which might have an impact in some aspects of the quality of life when compared to total thyroidectomy.

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Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302006000500016 ◽

2006 ◽

Vol 50 (5) ◽

pp. 930-933 ◽

Cited By ~ 9

Author(s):

Pedro Weslley S. do Rosário ◽

Álvaro Luís Barroso ◽

Leonardo Lamego Rezende ◽

Eduardo Lanza Padrão ◽

Michelle A. Ribeiro Borges ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Ovarian Function ◽

Radioiodine Therapy ◽

Unfavorable Outcome ◽

Favorable Outcome ◽

Spontaneous Abortions ◽

Radioiodine Treatment ◽

Ablative Therapy ◽

One Year

RATIONALE: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring. PATIENTS AND METHODS: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy (3.75.5 GBq 131I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception. RESULTS: Four (5.1%) of the 78 pregnancies resulted in spontaneous abortions. Three (4%) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6% of the children (mean ± SD: 3350 ± 450 g) and only one infant (1.3%) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome. CONCLUSION: We conclude that pregnancies that occur 12 months after ablative therapy are safe.

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Time course of Graves’ orbitopathy after total thyroidectomy and radioiodine therapy for thyroid cancer

Medicine ◽

10.1097/md.0000000000005474 ◽

2016 ◽

Vol 95 (48) ◽

pp. e5474 ◽

Cited By ~ 3

Author(s):

Camille Louvet ◽

Annamaria De Bellis ◽

Bruno Pereira ◽

Claire Bournaud ◽

Antony Kelly ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Time Course ◽

Radioiodine Therapy ◽

Graves Orbitopathy

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Total Thyroidectomy or Thyroid Lobectomy in Patients with Low-risk Differentiated Thyroid Cancer: Surgical Decision Analysis of a Controversy Using a Mathematical Model

World Journal of Surgery ◽

10.1007/s002680010215 ◽

2000 ◽

Vol 24 (11) ◽

pp. 1295-1302 ◽

Cited By ~ 49

Author(s):

Electron Kebebew ◽

Quan-Yang Duh ◽

Orlo H. Clark

Keyword(s):

Mathematical Model ◽

Thyroid Cancer ◽

Decision Analysis ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Low Risk ◽

Surgical Decision ◽

Thyroid Lobectomy

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Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review

Annals of Surgical Oncology ◽

10.1245/s10434-020-09481-8 ◽

2021 ◽

Author(s):

Carla Colombo ◽

Simone De Leo ◽

Marta Di Stefano ◽

Matteo Trevisan ◽

Claudia Moneta ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Risk Group ◽

Tertiary Care ◽

Thyroid Stimulating Hormone ◽

Low Risk ◽

The Other ◽

Intermediate Risk ◽

Other Hand

Abstract Background Controversies remain about the ideal risk-based surgical approach for differentiated thyroid cancer (DTC). Methods At a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up. Results Event-free survival by Kaplan–Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs. intermediate-risk, P = 0.553). Nevertheless, 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments. On the other hand, macrocarcinomas were significantly more persistent if treated with LT than with TT (low-risk, P = 0.036 vs. intermediate-risk, P = 0.004). Permanent hypoparathyroidism was more frequent after TT (P = 0.01). After LT, thyroglobulin (Tg)/thyroid-stimulating hormone (TSH) had shown decreasing trend in 68% of the event-free patients and an increasing trend in the persistent cases. Conclusions Lobectomy can be proposed for low-risk microcarcinomas, although in a minority of cases, additional treatments are needed, and a longer follow-up period usually is required to confirm an event-free outcome compared with that for patients treated with TT. On the other hand, to achieve an excellent response, TT should be favored for intermediate-risk micro- and macro-DTCs despite the higher frequency of postsurgical complications.

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Total Thyroidectomy and Low-Risk Thyroid Cancer: Are We Treating the Surgeon or Patient?

Annals of Surgical Oncology ◽

10.1245/s10434-021-09997-7 ◽

2021 ◽

Author(s):

Amanda M. Laird ◽

Toni Beninato

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Low Risk

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Utility of Stimulated Thyroglobulin in Reclassifying Low Risk Thyroid Cancer Patients’ Following Thyroidectomy and Radioactive Iodine Ablation: A 7-Year Prospective Trial

Frontiers in Endocrinology ◽

10.3389/fendo.2020.603432 ◽

2021 ◽

Vol 11 ◽

Author(s):

Anwar A. Jammah ◽

Afshan Masood ◽

Layan A. Akkielah ◽

Shaimaa Alhaddad ◽

Maath A. Alhaddad ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Prospective Trial ◽

Low Risk ◽

University Hospital ◽

Serum Thyroglobulin ◽

Risk Of Recurrence

ContextFollowing total thyroidectomy and radioactive iodine (RAI) ablation, serum thyroglobulin levels should be undetectable to assure that patients are excellent responders and at very low risk of recurrence.ObjectiveTo assess the utility of stimulated (sTg) and non-stimulated (nsTg) thyroglobulin levels in prediction of patients outcomes with differentiated thyroid cancer (DTC) following total thyroidectomy and RAI ablation.MethodA prospective observational study conducted at a University Hospital in Saudi Arabia. Patients diagnosed with differentiated thyroid cancer and were post total thyroidectomy and RAI ablation. Thyroglobulin levels (nsTg and sTg) were estimated 3–6 months post-RAI. Patients with nsTg <2 ng/ml were stratified based on their levels and were followed-up for 5 years and clinical responses were measured.ResultsOf 196 patients, nsTg levels were <0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg <0.1 ng/ml, 120 (98%) had sTg levels <1 ng/ml, with no structural or functional disease. sTg levels >1 occurred in 26 (35%) of patients with nsTg 0.1–2.0 ng/ml, 11 (15%) had structural incomplete response. None of the patients with sTg levels <1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg < 0.1 ng/ml) indicates a very low risk of recurrence that does not require stimulation. Stimulated thyroglobulin is beneficial with nsTg 0.1–2 ng/ml for re-classifying patients and estimating their risk for incomplete responses over a 7 years follow-up period.

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Hemithyroidectomy for Thyroid Cancer: A Review

Medicina ◽

10.3390/medicina56110586 ◽

2020 ◽

Vol 56 (11) ◽

pp. 586

Author(s):

Noor Addasi ◽

Abbey Fingeret ◽

Whitney Goldner

Keyword(s):

Thyroid Cancer ◽

Surgical Treatment ◽

Total Thyroidectomy ◽

Low Risk ◽

American Thyroid Association ◽

Well Differentiated ◽

Cancer Guidelines ◽

Personalized Approach ◽

Management Recommendations ◽

Cancer Network

Thyroid cancer incidence is on the rise; however, fortunately, the death rate is stable. Most persons with well-differentiated thyroid cancer have a low risk of recurrence at the time of diagnosis and can expect a normal life expectancy. Over the last two decades, guidelines have recommended less aggressive therapy for low-risk cancer and a more personalized approach to treatment of thyroid cancer overall. The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) thyroid cancer guidelines recommend hemithyroidectomy as an acceptable surgical treatment option for low-risk thyroid cancer. Given this change in treatment paradigms, an increasing number of people are undergoing hemithyroidectomy rather than total or near-total thyroidectomy as their primary surgical treatment of thyroid cancer. The postoperative follow-up of hemithyroidectomy patients differs from those who have undergone total or near-total thyroidectomy, and the long-term monitoring with imaging and biomarkers can also be different. This article reviews indications for hemithyroidectomy, as well as postoperative considerations and management recommendations for those who have undergone hemithyroidectomy.

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