Thyroid Surgery 101: Too Many Total Removals of the Thyroid Gland for Thyroid Cancer Even With Recent Less Aggressive Guidelines.

Thyroid Surgery 101: Too Many Total Removals of the Thyroid Gland for Thyroid Cancer Even With Recent Less Aggressive Guidelines.

Thyroid Surgery 101: Too Many Total Removals of the Thyroid Gland for Thyroid Cancer Even With Recent Less Aggressive Guidelines.

Thyroid Surgery 101: Too Many Total Removals of the Thyroid Gland for Thyroid Cancer Even With Recent Less Aggressive Guidelines.

images

DR.Guttler’s comments:

  1. The number of total thyroidectomies has not gone down despite recommendations encouraging less aggressive lobectomy for patients with small papillary thyroid cancers.
  2. Guidelines are saying that doing less is probably better.
  3.  84.3% of patients underwent a total thyroidectomy while 12.4% had a thyroid lobectomy
  4. thyroid-surgery
  5. even though they were small and low risk with metastatic disease.
  6. In light of overdiagnosis and overtreatment of nonaggressive papillary thyroid cancers, significant changes in the recommendations for surgical treatment of thyroid cancer have transpired over the past 12 years.
  7. There are several potential reasons why the frequency of lobectomies was low.
  8. First, in community settings where many thyroid surgeries are performed, the decision to perform a lobectomy vs total thyroidectomy may rest with a general surgeon.
  9.  Specialists such as endocrinologists and oncologists may not be making the call for lobectomy in conjunction with surgeons.
  10. One explanation is that nobody’s read a book; they’re operating and not keeping up because they do 20 other surgeries.
  11. They’ve kept up with some technology, but not necessarily a rare disease that you occasionally operate on.
  12.  Some specialists may be consciously choosing to overtreat based on anecdotal experience.
  13.  The decision to overtreat with thyroidectomy may be rooted in concerns about litigation.
  14.  Physicians who undertreat are more fearful of being sued than of overtreatment.
  15. Patients themselves may be requesting total thyroidectomies with the misguided notion that the cancer will never return if the thyroid is totally resected.
  16.  Advocating Active Surveillance observation vs surgery in small low-risk thyroid cancers is another way to decrease total thyroidectomies.
  17. REcent evidence that ethanol and radiofrequency could be used to ablate small low risk cancers as alternative to surgery or active surveillance.
  18. images
  19. Call me for my opinion 310-393-8860 or thyroid.manager@protonmail.com.
  20. Dr.G.

 

 

 

 

 

 

 

 

 

 

Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860