People with small thyroid tumors may soon be hearing their doctor recommend they undergo a partial thyroid removal rather than a total removal, based on new American Thyroid Association treatment guidelines. Duke endocrine surgeon Julie Ann Sosa, MD, says this shift toward "less is more" is due because “we are probably overtreating many low-risk thyroid cancers with surgery and radioactive iodine.”
Partial Thyroid Removal for Low-Risk Thyroid Cancer
Sosa was among four surgeons who served on the task force that wrote the new recommendations. She and her Duke colleagues conducted a study that was pivotal in the discussion about how the extent of surgery is associated with patient outcomes. That study analyzed more than 61,000 cases and found that, contrary to older guidance, removing the entire thyroid (total thyroidectomy) does not give a survival advantage when the tumor is small (less than 4cm) and deemed to be low-risk. In those cases, patients who choose lobectomy -- during which only the part of the thyroid that contains the tumor is removed -- can live just as long, and often with fewer side effects.
An Opportunity for Choice
“If we take your entire thyroid out, you have to take a medicine every day, so that’s a true quality-of-life issue,” Sosa says. Among people who have only part of the thyroid removed, the majority don’t have to take medication at all. In addition, Sosa says, the total thyroid removal carries a greater risk of other complications, including losing the ability to speak or breathe unassisted and having to take calcium supplements several times a day.
The upshot—in patients with small tumors, the extent of their disease, as well as the patient’s preference, should weigh heavily as a deciding factor. “This is a gray area,” Sosa says. “There’s an opportunity for choice.”