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01-05-2018 | Endocrine Tumors

Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule

Authors: Trevor E. Angell, MD, Chirag M. Vyas, MBBS, MPH, Justine A. Barletta, MD, Edmund S. Cibas, MD, Nancy L. Cho, MD, Gerard M. Doherty, MD, Atul A. Gawande, MD, Brooke E. Howitt, MD, Jeffrey F. Krane, MD, PhD, Ellen Marqusee, MD, Kyle C. Strickland, MD, PhD, Erik K. Alexander, MD, Francis D. Moore Jr., MD, Matthew A. Nehs, MD

Published in: Annals of Surgical Oncology | Issue 5/2018

Abstract

Background

Diagnostic hemithyroidectomy (HT) is the most widely recommended surgical procedure for a nodule with indeterminate cytology; however, additional details may make initial total thyroidectomy (TT) preferable. We sought to identify patient-specific factors (PSFs) associated with initial TT in patients with indeterminate thyroid nodules.

Methods

Retrospective analysis of all patients with a thyroid nodule ≥ 1 cm and initial cytology of atypia of undetermined significance or suspicious for follicular neoplasm between 2012 and 2015 who underwent thyroidectomy. Medical records were reviewed for patient demographics, neck symptoms, nodule size, cytology, molecular test results, final histopathology, and additional PSFs influencing surgical management. Variables were analyzed to determine associations with the use of initial TT. Logistic regression analyses were performed to identify independent associations.

Results

Of 325 included patients, 182/325 (56.0%) had HT and 143/325 (44.0%) had TT. While patient age and sex, nodule size, and cytology result were not associated with initial treatment, five PSFs were associated with initial TT (p < 0.0001). These included contralateral nodules, hypothyroidism, fluorodeoxyglucose avidity on positron emission tomography scan, family history of thyroid cancer, and increased surgical risk. At least one PSF was present in 126/143 (88.1%) TT patients versus 47/182 (25.8%) HT patients (p < 0.0001). Multivariate logistic regression analysis demonstrated that these variables were the strongest independent predictor of TT (odds ratio 45.93, 95% confidence interval 18.80–112.23, p < 0.001).

Conclusions

When surgical management of an indeterminate cytology thyroid nodule was performed, several PSFs were associated with a preference by surgeons and patients for initial TT, which may be useful to consider in making decisions on initial operative extent.

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Title: Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule
Authors: Trevor E. Angell, MD
Chirag M. Vyas, MBBS, MPH
Justine A. Barletta, MD
Edmund S. Cibas, MD
Nancy L. Cho, MD
Gerard M. Doherty, MD
Atul A. Gawande, MD
Brooke E. Howitt, MD
Jeffrey F. Krane, MD, PhD
Ellen Marqusee, MD
Kyle C. Strickland, MD, PhD
Erik K. Alexander, MD
Francis D. Moore Jr., MD
Matthew A. Nehs, MD
Publication date: 01-05-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6421-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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