Thyroid cancer management

Thyroid cancer is the commonest endocrine malignancy, yet management remains controversial. Many endocrinologists advocate diagnosis by fine needle aspiration (FNA), treatment by thyroidectomy, ablative radioiodine (131I) and TSH suppression, together with follow-up with 131I scans or thyroglobulin (Tg) measurements. 131I (therapy or diagnosis) is given only when TSH is > 30 mIU/I. With this strategy in mind, the aim of the present study was to audit existing clinical practice in a large Edinburgh teaching hospital to establish whether a need existed for local guidelines for the management of thyroid cancer.

Retrospective case-note audit of 46 patients, aged 55 (range 26-86) years, admitted between 1988 and 1993 with a diagnosis of thyroid cancer.

Our FNA false negative rate was high (13%), aspiration technique varied considerably, and cytological reporting was not standardized.

Three (11%) patients received 131I despite suboptimal TSH levels because of poorly developed mechanisms to prevent this, and 7 (25%) patients had inadequate suppression of TSH as a result of poor interspecialty communication.

Three (11%) patients were scanned despite TSH levels < 30 mIU/I, and in 5 (18%) Tg checks were incomplete.

This audit identifies several shortcomings from what might be considered optimum management of thyroid cancer; practice was far from uniform even among the endocrinologists within a single hospital and interdisciplinary communication was poor. A locally agreed and implemented protocol should address most of these problems and improve the care of thyroid cancer patients.