A total of 418 of the 681 patients had pathology showing papillary thyroid carcinoma and 243 of theses (58%) had a biopsy before surgery showing papillary cancer. A total of 77 of these patients had nodules smaller than 1.5 cm on ultrasound before surgery with 27 under 1 cm and 50 ranging in size from 1.1-1.5 cm. A total of 15 of the 27 nodules under 1 cm were appropriate for surveillance, 12 were inappropriate, and none were ideal. Of the 50 nodules measuring 1.1-1.5 cm in size, 36 were appropriate, 9 were inappropriate, and 5 were ideal for active surveillance.
The patients with nodules less than 1cm who would have met the criteria for surveillance were treated with total thyroidectomy with central lymph node dissection in 13 of 15 patients, all with negative lymph nodes. Complications in this group included a chipped tooth and breast hematoma. No patients died or had recurrence.
The patients with nodules of 1.1.-1.5cm who met criteria for active surveillance had total thyroidectomy 95% of the time (39/41 patients). A total of 33 of the patients had central lymph node dissection with 14 with spread to lymph nodes (largest 4mm). No patients had death or recurrence. One patient had permanent vocal cord paralysis and one patient had permanent hypocalcemia. The total rate of permanent complications was ~5%.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
If we apply active surveillance as an option for treatment of papillary thyroid cancer up to 1.5cm, 25% of patients may be able to participate in surveillance. Offering patients active surveillance is safe and would allow avoidance of surgery and its possible complications. Additionally, active surveillance would avoid the need for thyroid hormone replacement.
— Julie Hallanger Johnson, MD
ATA THYROID BROCHURE LINKS
Thyroid Cancer (Papillary and Follicular): https://www. thyroid.org/thyroid-cancer/
Thyroid Surgery: https://www.thyroid. org/thyroid-surgery/