The incidence of papillary thyroid microcarcinoma in patients who underwent total thyroidectomy due to benign disease and our clinical approach

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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Incidentally Discovered Papillary Thyroid Microcarcinoma in Patients Undergoing Thyroid Surgery for Benign Disease

10.21203/rs.3.rs-1229136/v1 ◽

2022 ◽

Author(s):

Joaquin de Carlos ◽

Ander Ernaga ◽

Ana Irigaray ◽

Jose Javier Pineda ◽

Ana Echegoyen ◽

...

Keyword(s):

Thyroid Surgery ◽

Cohort Analysis ◽

Multivariate Logistic Regression Analysis ◽

Benign Disease ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

Maximal Diameter ◽

Benign Pathology ◽

Retrospective Cohort Analysis

Abstract IntroductionIncidence of thyroid carcinoma (TC) has grown significantly over the last few decades worldwide, partly due to the increase detection of small thyroid microcarcinoma (TMc). TMc are tumors with a maximal diameter ≤ 1 cm, identified during histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancy. The aim of this study is to investigate the prevalence of papillary thyroid microcarcinoma (PTMc) according to the nature of benign pathology that submit patients to thyroid surgery and its trend evolution.MethodsRetrospective cohort analysis of 1815 patients who underwent total thyroidectomy for non-malignant disease from 2005 to 2020. ResultsThe mean age of subjects was 53.5 years, with a higher proportion of women (1481, 82.1%). A total of 167 PTMc (9.3%) were incidentally discovered. Multivariate logistic regression analysis shows no differences in prevalence according to sex or age in patients with PTMc compared to those with final benign histology. Multinodular goiter increases the risk of PTMc with an odds ratio of 2.2 (p=0.001) compared to Hashimoto's thyroiditis and Graves´ disease (GD). There is a statistically significant increase in the incidence of PTMc in the group operated between 2017-2020 vs. 2005-2008 (p=0.005)ConclusionOverall prevalence of PTMc in patients who underwent thyroid surgery for benign disease was 9.3%. Thyroid nodular hyperplasia was the most frequent benign pathology associated to this occult cancer as compared to Hashimoto or GD. Gender and age were not correlated with prevalence of TMc. Over the years, surgical findings of PTMc have grown, particularly in the 2017-2020 period.

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