Thyroid Surgery 101: Too Many Total Removals of the Thyroid Gland for Thyroid Cancer Even With Recent Less Aggressive Guidelines.
- The number of total thyroidectomies has not gone down despite recommendations encouraging less aggressive lobectomy for patients with small papillary thyroid cancers.
- Guidelines are saying that doing less is probably better.
- 84.3% of patients underwent a total thyroidectomy while 12.4% had a thyroid lobectomy
- even though they were small and low risk with metastatic disease.
- 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.
- There are several potential reasons why the frequency of lobectomies was low.
- 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.
- Specialists such as endocrinologists and oncologists may not be making the call for lobectomy in conjunction with surgeons.
- One explanation is that nobody’s read a book; they’re operating and not keeping up because they do 20 other surgeries.
- They’ve kept up with some technology, but not necessarily a rare disease that you occasionally operate on.
- Some specialists may be consciously choosing to overtreat based on anecdotal experience.
- The decision to overtreat with thyroidectomy may be rooted in concerns about litigation.
- Physicians who undertreat are more fearful of being sued than of overtreatment.
- Patients themselves may be requesting total thyroidectomies with the misguided notion that the cancer will never return if the thyroid is totally resected.
- Advocating Active Surveillance observation vs surgery in small low-risk thyroid cancers is another way to decrease total thyroidectomies.
- REcent evidence that ethanol and radiofrequency could be used to ablate small low risk cancers as alternative to surgery or active surveillance.
- Call me for my opinion 310-393-8860 or [email protected]