Aim: The British Thyroid Association published guidelines on the management of differentiated thyroid cancer and medullary thyroid cancer in 2007. The aim of our audit was to assess compliance with these guidelines.
Methods: Electronic records of patients operated on and followed up in our hospital from January 2009 to December 2013 were reviewed retrospectively.
Results: Forty-nine patients fulfilling these criteria were identified. 61% patients presented with a solitary nodule and 26% had diffuse neck swelling. Only 16% patients had suspicious features on ultrasound. Fine needle aspiration and cytology (FNAC) was performed in 44 out of the 49 cases with 61% being ultrasound-guided. 43% of those who underwent FNAC were diagnosed with Thy3, 7% with Thy4 and 20% with Thy5. Seven out of the ten patients with Thy1 had a repeat FNAC. 90% of cases were discussed at the multi-disciplinary meeting. The mean duration from cytological diagnosis to surgery was 11 weeks; Thy3 and Thy4 cases were operated in less than 8 weeks, apart from one case, which was after 12 weeks. The majority of patients underwent staged total thyroidectomy. Eight patients developed post-operative hypoparathyroidism and seven had nerve palsies. Histological diagnosis was papillary thyroid carcinoma in 76%. Four patients had medullary thyroid cancer and the remainder follicular. Post-operatively 82% of patients in whom radioiodine was indicated received it and 78% of eligible patients had TSH suppression. 60% of patients did not have a baseline thyroglobulin and only 63% had a follow-up thyroglobulin as part of surveillance.
Conclusions: Patients with thyroid cancer were managed in conformity with the guidelines. However, we need to ensure that baseline thyroglobulin and annual follow-up thyroglobulin are checked in all cases of papillary and follicular thyroid carcinoma. We should also aim for improvement in TSH suppression following surgery.