GAUGING THE EXTENT OF THYROIDECTOMY FOR INDETERMINATE THYROID NODULES: AN ONCOLOGIC PERSPECTIVE

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Disease Management

Background:

• Indeterminate thyroid nodules (ITNs) pose challenges in surgical management, risking both undertreatment and overtreatment.
• Diagnostic lobectomy (DL) for cancer may necessitate completion thyroidectomy (CT), while initial total thyroidectomy (TT) for benign ITN leads to lifelong hormone replacement.

Purpose of the Study:

• To evaluate the accuracy of initial thyroidectomy extent for ITNs.
• To identify factors associated with oncologic undertreatment or overtreatment in ITN management.

Main Methods:

• Retrospective analysis of a single institution's thyroid surgery database for adult patients with ITN.
• Multivariate logistic regression to identify predictors of inappropriate initial surgical extent.

Main Results:

• Of 639 ITN patients, 9.3% required CT. 19.0% with benign final pathology underwent TT (excluding goiters).
• Female gender was linked to TT for benign disease (OR 2.1). Age >45 predicted appropriate DL use (OR 2.6).
• Suspicion for papillary thyroid carcinoma (OR 5.7) and frozen section (OR 9.7) predicted appropriate initial TT. Follicular lesion of undetermined significance (FLUS) had high CT rates (11.6%).

Conclusions:

• Approximately 30% of ITN patients experienced inappropriate initial thyroidectomy extent.
• Improved pre-operative tools are crucial for optimizing surgical decisions in ITN cases, balancing malignancy detection and avoiding overtreatment.