Completion Thyroidectomy is Less Common Following Updated 2015 American Thyroid Association Guidelines.

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• The 2015 American Thyroid Association (ATA) guidelines suggested thyroid lobectomy alone for low-risk differentiated thyroid cancers (DTC) between 1-4 cm.
• This study investigates the impact of these guidelines on completion thyroidectomy (CT) rates.

Purpose of the Study:

• To evaluate the change in CT rates for low-risk DTC after the 2015 ATA guidelines.
• To identify factors influencing surgical decisions for CT in low-risk DTC patients.

Main Methods:

• A retrospective review of patients with DTC who underwent initial thyroid lobectomy between 2014 and 2018.
• Patients were categorized into pre-guideline (2014-2015) and post-guideline (2016-2018) cohorts.
• Comparison of CT rates and analysis of demographic and tumor characteristics associated with CT.

Main Results:

• A total of 163 patients were included; 63 pre-guideline and 100 post-guideline.
• CT rate decreased from 65.1% to 43.0% overall (p < 0.01).
• For low-risk DTC (1-4 cm), CT decreased by 48.6% (48.6% pre vs. 25.0% post, p=0.02).
• Tumor size, capsular invasion, and multifocality were associated with CT in the post-guideline low-risk group.

Conclusions:

• The 2015 ATA guidelines led to a significant reduction in CT for low-risk DTC (1-4 cm).
• Despite guideline changes, 25% of these patients still underwent CT, suggesting other influencing factors.
• Factors like tumor size, capsular invasion, and multifocality play a role in surgical decision-making for CT.