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PurposeThyroid cancer incidence is rising, possibly secondary to increased imaging and surveillance. Based on rural access to care disparities, we hypothesized that incidence would be greater in urban compared to rural counties with no significant difference in long‐term survival.MethodsAn observational study was performed on thyroid cancer patients using Surveillance Epidemiology and End Results data (2000‐2012). Age‐adjusted incidence rates, incidence rate ratios, and survival rates were calculated across rural‐urban designations.FindingsIncidence rates were 11.2, 9.8, and 10.1 per 100,000 for urban, rural‐adjacent, and rural‐nonadjacent counties, respectively. Statistically significantly lower incidence was noted in rural‐adjacent and rural‐nonadjacent compared to urban areas. Five‐year and 10‐year survival was significantly lower in rural‐nonadjacent counties compared to urban counties.ConclusionsHigher incidence and increased long‐term survival for thyroid cancer were noted in urban areas compared to rural areas. It is uncertain if rural‐urban differences in long‐term survival reflect health care disparities, differences in therapy, or other origins.

Asymptomatic primary hyperparathyroidism is a very common endocrine condition, yet management of this disease process remains controversial. Primary hyperparathyroidism can lead to a myriad of symptoms which not only decreases the quality of life of patients but also increases the risk of cardiovascular disease, osteoporosis, and kidney stones. Parathyroidectomy is the only known cure for the disease. This review explores the definition of asymptomatic primary hyperparathyroidism, the burden of disease, and the overwhelming benefits of parathyroidectomy.

BackgroundThyroid cancer diagnoses are often discovered after diagnostic thyroid lobectomy. Completion thyroidectomy (CT) may be indicated for intermediate or high‐risk tumors to facilitate surveillance and/or adjuvant treatment. The completeness of thyroid resection and the safety of CT compared to total thyroidectomy (TT) is unclear. We assessed outcomes after TT or CT to determine completeness of resection and risk of complications.MethodsPatients undergoing TT or CT between 2000 and 2018 were retrospectively reviewed. Pathology, unstimulated thyroglobulin (uTg), parathyroid hormone (PTH), rates of hematoma, and recurrent laryngeal nerve (RLN) injury were compared.ResultsDifferentiated thyroid cancer (DTC) was identified in 954 patients undergoing TT and 142 patients undergoing CT. Postoperative uTg at 6 months was not different between TT and CT, 0.2 vs 0.2 ng/mL, P = .37.Transient hypoparathyroidism with immediate postoperative PTH less than 10 was more common after TT, 14.3 vs 6.0% (P = .009). No differences were noted regarding postoperative hematoma, transient RLN injury, permanent hypoparathyroidism, and permanent RLN injury.ConclusionsIf CT is required for DTC, a complete resection, as assessed by postoperative uTg, can be achieved. Furthermore, CT is significantly less likely to result in transient hypoparathyroidism and poses no additional risk of RLN injury, hematoma, or permanent hypoparathyroidism.

Context Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. Objective To understand factors associated with adoption of AS. Design/Setting/Participants We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for two hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Main Outcome Measure Adoption of AS (non-adopters vs adopters, who respectively did not recommend or recommended AS at least once; partial vs full adopters, who respectively recommended AS for one or both cases) Results The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Non-adopters (45.7%) were significantly (p<0.001) less likely than adopters to: practice in academic settings, see >25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (p=0.04), know how to determine a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Non-adopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (p=0.03) and more likely to be anxious (p=0.04), have reservations (p=0.03), and have concerns about the psychological burden (p=0.009) of AS. Few respondents (3.2%) believed patients were aware of AS. Conclusions Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.

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