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The 2015 American Thyroid Association guidelines and trends in hemithyroidectomy utilization for pediatric thyroid
Eli Stein1, Mehul V Raval2,3, Inbal Hazkani1,4
1Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Pediatric differentiated thyroid cancer management changed after 2015 American Thyroid Association guidelines. Hemithyroidectomy use increased significantly in children, indicating a shift in surgical approaches for thyroid cancer.
Area of Science:
- Pediatric Oncology
- Surgical Endocrinology
- Clinical Guidelines Impact
Background:
- The American Thyroid Association (ATA) issued initial pediatric thyroid cancer management guidelines in 2015.
- Evaluating changes in hemithyroidectomy rates for pediatric differentiated thyroid cancer post-guideline release is crucial.
Purpose of the Study:
- To assess the impact of the 2015 ATA guidelines on hemithyroidectomy utilization for pediatric differentiated thyroid cancer.
- To identify factors associated with hemithyroidectomy use in this patient population.
Main Methods:
- Analysis of the National Cancer Database for 4776 patients aged 18 years or younger with differentiated thyroid cancer.
- Utilized causal impact time-series analysis and logistic regression to evaluate trends and associated factors.
Main Results:
- Hemithyroidectomy rates increased significantly post-2015 (8.4% predicted vs. 12.6% actual, p=0.001).
- Factors associated with lower hemithyroidectomy use included papillary histology, tumor size >1 cm, nodal examination, and positive nodes.
Conclusions:
- There was a significant increase in hemithyroidectomy utilization for pediatric differentiated thyroid cancer following the 2015 ATA guidelines.
- The study highlights a notable shift in surgical management strategies for pediatric thyroid cancer.
Background:
In 2015, the American Thyroid Association (ATA) released its inaugural recommendations for the management of thyroid cancer in children. We aim to evaluate whether there has been a change in hemithyroidectomy utilization for pediatric differentiated thyroid cancer, and the association between those changes and the release of the ATA guidelines.
Methods:
The National Cancer Database was queried and identified 4776 patients ≤18 years old with differentiated thyroid cancer. Causal impact time-series analysis and logistic analysis were utilized to assess factors associated with use of hemithyroidectomy.
Results:
Post-2015 hemithyroidectomy rate was greater than predicted based on preguideline trends (predicted: 8.4%, actual: 12.6%, p = 0.001). In logistic analysis of factors associated with hemithyroidectomy use, we find that Papillary histology, tumor size >1 cm, nodal examination, and positive nodes were associated with lower rate of hemithyroidectomy (OR: 0.23, 0.51, 0.62, and 0.18, respectively).
Conclusion:
There has been a significant increase in hemithyroidectomy utilization for pediatric differentiated thyroid cancer.
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