Endocrine Abstracts

JOINT3792

Introduction: In the past decade, differentiated thyroid cancer (DTC) management has shifted towards de-escalation to reduce overtreatment and improve quality of life. Guidelines now favor less aggressive surgery, with lobectomy preferred for low-risk tumors. This study aimed to determine the proportion of patients in Romania eligible for initial hemithyroidectomy (HT) according to ATA guidelines and the frequency of recommended completion of total thyroidectomy (TT).

Methods: This retrospective cohort study included patients diagnosed with DTC who were treated or followed up in our department between 2015 and 2021. Exclusion criteria were ectopic tumors, missing data or follow-up <12 months, and age under 18 years at surgery. Eligibility for initial HT was defined by the following criteria: DTC ≤4 cm, no suspicious lymph nodes and no extrathyroidal extension on preoperative imaging, and no distant metastases. Patients classified postoperatively as intermediate or high risk according to the 2015 ATA guidelines were considered to require a completion TT.

Results: Records of 169 patients were review. 62 patients were excluded for insufficient data (no preoperative evaluation available) or follow-up less than 12 months. Of the 107 patients included, 51 (45,9%) would have been eligible for initial HT. Among them, 14 (27,4%) would have required a completion TT after postoperative initial risk classification, of whom 7 patients would have excellent response to therapy. In the HT-eligible group, 49 had papillary thyroid cancer (PTC), including 15 cases (29.4%) of microcarcinoma, along with 1 case of follicular carcinoma (FTC) and 1 case of Hürthle cell carcinoma. In the TT-eligible group, there were 49 cases of PTC (including 3 tall cell variants), 2 FTC, 3 Hürthle cell carcinomas, and 2 poorly differentiated thyroid carcinomas. The mean age was similar between the HT-eligible and TT-eligible groups (49 ± 14.52 vs. 48.8 ± 13.75 years), as well as presence of multifocality, in 17 cases (32.6%) in the HT-eligible group and 18 cases (31.5%) in the TT-eligible group. Patients eligible for HT had significantly higher remission rates and lower rates of persistent and recurrent disease compared to those who required upfront total thyroidectomy (71.1% vs. 33.9%, P < 0.0001).

Conclusions: A less extensive surgical approach with appropriate follow-up can be a valid alternative to total thyroidectomy in selected cases, given the potential benefits of a stepwise strategy and the favourable prognosis of low-risk DTC. This highlights the importance of shared decision-making in managing patients with DTC ≤4 cm.