Endocrine Abstracts

Thyroid cancer is the commonest endocrine malignancy. Recently, a European consensus statement for the management of patients with differentiated thyroid carcinoma has been published¹. The diagnostic and follow up protocols differ from previous guidelines by the use of neck ultrasound and recombinant human thyroglobulin (rhTSH) measurements. The aim of this study was to determine the current management of suspicious thyroid nodules and the follow up of thyroid cancer patients. Findings were then compared to the recommended pre-surgical evaluation of thyroid nodules, and follow-up protocols for thyroid cancers in the European consensus statement. Reports from all patients(N=262) in whom thyroid fine needle aspiration cytology(FNAC) was carried out from January 2000 to December 2005 at the Adelaide and Meath Hospital were reviewed. From this cohort we identified 71 patients with suspected neoplasm. 45 proceeded to thyroid lobectomy or total thyroidectomy, and histopathology confirmed 19 malignancies. We analysed the clinical presentation, radiological investigations, FNAC reports and biochemical measurements in all patients with suspected malignancy. Review of the follow up of thyroid cancers examined the use of thyroid ultrasound, thyroglobulin measurement and rhTSH stimulation tests. Overall, patients received appropriate clinical examination and investigation with radiologically unguided FNAC. Deficiencies identified were the patchy use of radiological and biochemical investigations, which differed depending on the speciality to which the patient was referred. Thyroid ultrasound caused diagnostic delay due to limited availability. During follow up thyroid ultrasound was not used to screen for recurrence. The rhTSH stimulation test was carried out on 2 patients. These findings demonstrate the introduction of the European consensus statement for the management of patients with differentiated thyroid carcinoma will require modification of current protocols with significant resource implications.

1. European consensus for the Management of Patients with Differentiated Thyroid Carcinoma of the Follicular Epithelium. Eur J Endocrinology 2006 154 787–803.