Lobectomy and Thyroidectomy without Radioactive Iodine Ablation: Are They Safe Treatments?
The February 2011 issue of Clinical Endocrinology had an article entitled “Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablations is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer.”
In it, the researchers set out to examine thyroid disease recurrence in patients who were treated with a lobectomy or total thyroidectomy—and no radioactive iodine remnant ablation.
This study was a retrospective review. There were 289 patients, and they underwent either thyroid lobectomy (n=72) or total thyroidectomy (n=217) without radioactive iodine remnant ablation. The patients were followed in a tertiary referral center using modern disease detection tools.
Of the patients, 89% had papillary thyroid cancer without clinically evident lymph node metastases (91%). Some patients—156 out of the 289 (55%)—had primary tumors greater than 1 cm; 28 out of 289 (10%) had extrathyroidal extension.
There was a median follow-up of 5 years. In the group treated with total thyroidectomy, there was a structural disease recurrence in 2.3% of the patients (5 out of 217). For the group treated with thyroid lobectomy, 4.2% of the patients (3 out of 72) had a recurrence.
It’s worth noting that size of the primary tumor, presence of cervical lymph node mestastases, and ATA risk category were all statistically significant predictors of disease recurrence. However, serum thyroglobulin was not helpful in identifying the presence of persistent or recurrent structural disease.
Of the 8 patients who had recurrent disease, 88% of them (7 out of 8) were clinically disease-free after additional therapies.
The authors of the study concluded that initial risk stratification can identify appropriate patients to undergo treatment without radioactive iodine remnant ablation. These patients have a very low risk of structural disease recurrence. The study’s data strongly support careful patient selection to the initial management of thyroid cancer.
In September 2011, Clinical Thyroidology published a review of this particular study. The journal pointed out that the “therapeutic approaches for intermediate-risk thyroid cancers, defined as those having a diameter of <4 cm and the absence of microscopic extrathyroidal or intrathyroidal invasion and cervical lymph-node metastases, are particularly subject to person al opinion and experience.”1
The Clinical Endocrinology study, then, was very helpful because it showed the experience of the study authors in treating intermediate-risk patients. For those patients, the guidelines of the American and European Thyroid Associations leave much to the discretion of the physician. A study such as this one is helpful in making informed decisions about how to treat intermediate-risk patients.