The British Thyroid Association recommends that a specialist multidisciplinary team (MDT) is responsible for thyroid cancer management. In accordance with this recommendation, a team was formed to manage thyroid carcinoma in a tertiary referral centre. The team included endocrinology, general surgery, ENT, cytology, radiology and radiation oncology consultants.
This audit was performed to assess management of thyroid carcinoma before the establishment of the MDT and to identify areas for improvement.
Eighty-five patients (60 female) were included and most had undergone surgery since 2000 (4 patients 19901999). In total 6 surgeons had performed thyroid surgery; one general surgeon was responsible for 87% of cases. Where data was available with regard to the extent of surgery, 68% had had thyroidectomy without neck dissection. The histological diagnosis was papillary 64%, follicular 29%, medullary 4% and anaplastic 3%. The surgical practice of limited resection was reflected in histology reporting; the extent of nodal disease could not be reported in 58.4% of cases (Nx).
81.2% of patients with differentiated carcinoma had radio-iodine ablation post-operatively. Three patients had external beam radiation. TSH suppression was not achieved in 66% of patients; 37% of these were not managed by endocrinology. Only 69% of patients had had a basal thyroglobulin measured and 36.7% a stimulated thyroglobulin; in patients with undetectable basal levels, only two had detectable thyroglobulin when TSH was >50.
This audit highlights the need to plan the extent of surgical resection prior to completion thyroidectomy and for management of TSH suppression by an endocrinologist.