Endocrine Abstracts

JOINT4038

Introduction: Papillary thyroid carcinoma (PTC) has a rising incidence and a good prognosis in low-risk cases. The choice of surgery in low-risk papillary thyroid carcinoma (PTC) is important in order to balance recurrence rates and surgical complications.

Objective: To evaluate whether the extent of thyroidectomy influences survival and recurrence rates in patients with low-risk-PTC.

Methods: A retrospective analysis was conducted for all patients treated at our institution who had low-risk papillary thyroid carcinoma and underwent either lobectomy or total thyroidectomy(TT), between 2015-2021. Exclusion criteria included patients treated with radioactive iodine post-surgery and those without complete postoperative follow-up. Recurrence was defined as the presence of structural evidence of disease(confirmed by cytology or post-contralateral lobectomy histology), or biochemical recurrence, defined as a serum TG value>30 ng/mL with stable TSH in patients with lobectomy, or positive ATG(> 115) with an upward trend.

Results: Fifty patients who underwent thyroidectomy were included. The preoperative cytology was malignant in 27%. TT was performed in 25 patients, 80% female, with a mean age of 60 years and a mean follow-up time of 9 years. The lobectomy group included 25 patients, 92% female, with a mean age of 63 years and a mean follow-up time of 10 years. Tumor size was similar between both groups (0.7 cm for TT and 0.6 cm for lobectomy). Biochemical recurrence occurred in 4 patients from the lobectomy group: 2 with elevated TG and no suspicious lesions found on ultrasound, who are being managed with active surveillance; 1 with rising ATG and a 5 mm nodule with subcentimetric lymph nodes, also under active surveillance; and 1 with a suspicious nodule and a doubling of TG levels over 3 months, for whom TT will be performed. No recurrences were observed in the TT group. There was no significant difference in disease-free survival between groups. Hypothyroidism developed in all TT patients and 92% of lobectomy patients, with higher levothyroxine doses in the TT group (115.8±27.3 mg vs 71.5±49.4 mg). Surgical complications were more common in the TT group, including transient dysphonia(20% (5/25) vs 12%(3/25) and transient hypoparathyroidism(in 8% (2/25). Overall, 4 patients were discharged, 1 passed away unrelated to thyroid cancer, and the remaining 45 continued follow-up.

Conclusion: This study suggests that the extent of thyroidectomy does not influence survival in low-risk PTC, and lobectomy may be a suitable option due to lower rates of hypothyroidism and postoperative complications. However, these data need to be confirmed in multicenter studies.