BACKGROUND
Treatment of cancer in the thyroid gland, a butterflyshaped organ in the front part of the neck that makes thyroid hormone, generally requires thyroid surgery. In the past, the most common way to treat thyroid cancer was removal of the whole thyroid gland (called a total thyroidectomy). A major reason for this was that doctors were afraid that if any thyroid tissue was left behind after initial thyroid cancer surgery, this cancer might come back in the remaining thyroid tissue (called cancer recurrence). If this were to happen, more surgery might be needed to remove the recurrent cancer. Such repeat surgery is often more difficult than the first surgery, with higher risk of surgical complications. In addition, total thyroidectomy has significant drawbacks/risks compared to removal of just that part of the thyroid that contains cancer (called a thyroid lobectomy). These include lifelong need to take a daily thyroid hormone pill after surgery as well as the low risk of surgical complications, including risk of permanent low body calcium levels after surgery, voice changes after surgery and risk of breathing problems requiring placement of a tracheostomy tube (a breathing tube that goes through the skin into the windpipe to breathe through).

Recent studies have suggested that thyroid lobectomy for treatment of thyroid cancer is safe and that the risk of cancer recurrence in that thyroid tissue not removed during surgery is very low. For this reason, and also because of the lower risks and fewer drawbacks associated with partial thyroid removal, thyroid lobectomy for treatment of thyroid cancer is becoming increasingly common. Indeed, the American Thyroid Association (ATA) guidelines for the treatment of thyroid cancer published in 2015 recommend thyroid lobectomy as an option for people undergoing surgery for thyroid cancer.

The authors of the study described here further address whether thyroid lobectomy is an acceptable treatment for thyroid cancer by comparing the risk of thyroid cancer recurrence between people undergoing total thyroidectomy and people having a thyroid lobectomy.

THE FULL ARTICLE TITLE
Kheng M, et al. Reoperation rates after initial thyroid lobectomy for patients with thyroid cancer: a national cohort study. Thyroid. Epub Jul 25 2024; doi: 10.1089/ thy.2024.0128. PMID: 39049736.

SUMMARY OF THE STUDY
The authors of this study reviewed medical insurance claims records for adults who underwent either total thyroidectomy or thyroid lobectomy for the treatment of thyroid cancer at over 1000 different United States Hospitals. The frequency of total thyroidectomy compared to thyroid lobectomy was evaluated for thyroid cancer patients who underwent thyroid surgery before 2015 to those whose thyroid surgery occurred after publication of the 2015 ATA guidelines. Thyroid cancer recurrence over time was evaluated for each group.

A total of 65,627 thyroid cancer patients were included in the study, with the rate of thyroid lobectomy for treatment increasing from 21% in the 2 years prior to 2015, to 37% in the subsequent 5 years. This increased thyroid lobectomy rate was slightly higher when the operation was performed at an institution specializing in this kind of surgery (called a high-volume center). Overall, the rate of cancer recurrence was found to be similar between thyroid cancer patients undergoing total thyroidectomy and those for whom thyroid lobectomy was performed.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This work adds to the growing body of evidence supporting thyroid lobectomy as a management alternative for thyroid cancer and indicates that selection of this option is increasingly frequent. The study authors found that the risk of thyroid cancer recurrence following thyroid lobectomy is similar to that seen when total thyroidectomy is performed for thyroid cancer. Moreover, the surgical complication risk associated with thyroid lobectomy is lower than that of total thyroidectomy and, unlike total thyroidectomy, many people do not need to take a thyroid hormone pill after thyroid lobectomy. Finally, this work indicates that thyroid cancer surgeons do take new published treatment guidelines into account when considering treatment options for people diagnosed with thyroid cancer. Although the ultimate choice regarding the extent of thyroid surgery should always involve an individualized discussion between a person diagnosed with thyroid cancer and their surgeon, the results of this study, taken together, support thyroid lobectomy as a safe treatment option.

— Jason D. Prescott, MD PhD

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