Endocrine Abstracts

Background: Recent guidelines recommend lobectomy (LOB) when compared to total thyroidectomy (TTX) as the preferred approach for patients with low-risk differentiated thyroid cancer (DTC). Major advantages are the avoidance of lifelong hormone replacement therapy and the absence of any risk for contralateral recurrent laryngeal nerve palsy and postoperative hypoparathyroidism with no or minimal increased risk for adverse oncological outcomes. However, this limited approached still has not been universally adopted.

Methods: We performed a retrospective analysis of prospectively collected data of consecutive patients with DTC undergoing thyroid surgery between July 2015 and June 2022 at our tertiary referral center. Patients were stratified low, intermediate and high-risk according to the ATA guidelines and staged according to the current TNM classification. Treatment recommendations were made by the local thyroid board and generally based on the 2015 ATA guidelines and 2019 Swiss recommendations. Patients were followed every 6 to 12 months by neck ultrasound. Data on oncological and safety outcome were analyzed and are presented by descriptive statistics.

Results: 277 patients (74.7% females, median age 50.3 years, range 16-80 years) underwent thyroid surgery for DTC with 146 (52%) assigned to the ATA low-risk group. The median follow-up time was 2.36 years. 118 (42.6 %) of low-risk patients were treated with LOB (62.7% pT1a, 28.8% pT1b, 8.5% pT2). Patients treated with TTX (10.7% pT1a, 42.9% pT1b, 46.4% pT2) 28 (19.2%) received additional radioiodine (22 adjuvant, 6 remnant ablation). In the LOB group no recurrence was observed and 1 patient treated with TTX and adjuvant radioiodine was suspicious for a structural relapse. In the LOB group 43 (36.4%) patients met recommended TSH goals with no additional levothyroxine replacement. Transient RLNP occurred in 3 patients (2.5%) of the LOB and 1 patient (3.6%) of the TTX group. Transient hypoparathyroidism occurred in 4 (14.3%) of the TTX group.

Conclusion: In patients with low-risk DTC lobectomy does not carry an increased risk fur recurrence, obviates the need for lifelong thyroid hormone replacement in the majority of patients and should be reinforced as the preferred surgical strategy.