Less is More: The Impact of Multidisciplinary Thyroid Conference on the Treatment of Well‐Differentiated Thyroid Carcinoma

Moore, Michal C.; Postma, Emily L.; Gray, Katherine D.; Ullmann, Timothy M.; Hurley, James R.; Goldsmith, Stanley J.; Sobel, Vivian; Schulman, Aaron; Scognamiglio, Theresa; Christos, Paul J.; Hassett, Erin; Luick, Jessica; Whitehall, Dana; Zarnegar, Rasa; Fahey, Thomas J.

doi:10.1007/s00268-017-4308-9

Cited by 13 publications

(6 citation statements)

References 31 publications

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“…This approach has also led to our adherence to guidelines, as has been reported by Moore et al in New York, where a similar change in RAI usage was reported following publication of the 2009 guidelines, with management decisions made within a multi-disciplinary environment. 20 The reduction in the use of RAI was accompanied by more aggressive surgery in our study, in particular, CLND. The indications for and the extent of lymph node dissection in DTC patients have always been controversial.…”

Section: Discussionsupporting

confidence: 46%

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Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

Sia

Dave

Nour

et al. 2019

ANZ Journal of Surgery

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Background The 2009 American Thyroid Association (ATA) three‐tiered risk stratification, and its updated version in 2015, provided clearer guidance on the use of radioactive iodine (RAI) ablation in differentiated thyroid cancer (DTC) patients. This study examines the impact of these guidelines on RAI use in our institution. Methods Patients diagnosed with DTC during three different time periods (group 1: 2002–2006, group 2: 2010–2014 and group 3: 2017–2018) were identified and risk stratified according to the ATA guidelines. RAI use and extent of surgery were compared between the three groups. Categorical variables were analysed using Fisher's exact (2 × 2) and chi‐squared (>2 × 2) tests. Results A total of 415 patients were included (group 1 = 88, group 2 = 215, group 3 = 112). The proportion of patients having total thyroidectomy were 84.6, 84.7 and 69.6% in groups 1, 2 and 3, respectively (P = 0.003). Central lymph node dissection was significantly higher in the more contemporary groups compared to group 1 (9.1 versus 41.9 versus 64.3%, P < 0.001). Overall, fewer patients received RAI in more recent times (76.6 versus 54.8 versus 26.8%, P < 0.001), most evident in the low‐risk patients (70 versus 29.1 versus 5.1%, P < 0.001). In the high risk group, the majority received RAI, with no difference between the groups. Conclusion Comparing DTC patients treated in our unit before and after publications of the 2009 and 2015 ATA guidelines, more nodal surgery was performed with less RAI administered in the latter groups. Better risk stratification according to the ATA guidelines has allowed more judicious use of RAI ablation.

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Section: Discussionsupporting

confidence: 46%

“…This approach has also led to our adherence to guidelines, as has been reported by Moore et al . in New York, where a similar change in RAI usage was reported following publication of the 2009 guidelines, with management decisions made within a multi‐disciplinary environment …”

Section: Discussionmentioning

confidence: 99%

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

Sia

Dave

Nour

et al. 2019

ANZ Journal of Surgery

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“…In a study from the University of California, San Francisco, only 101 of 394 patients (25.6%) who underwent thyroid lobectomy between 2000 and 2010 should have had adjuvant radioactive iodine treatment according to the new ATA guidelines, whereas 59.6% had radioactive iodine treatment corresponding to the revised 2009 ATA guidelines . A recent study by Moore et al identified that multidisciplinary conferences with ATA guidelines implementation resulted in a decrease in radioactive iodine treatment rates without an increase in recurrence rates. Similarly, we found a large and clinically meaningful decrease in the use of radioactive iodine treatment in the 2016 cohort compared with the 2013 to 2014 cohort, and the data are compatible with a decrease as large as 38%.…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma

Hirshoren

Kaganov

Weinberger

et al. 2018

JAMA Otolaryngol Head Neck Surg

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“…An enlarged thyroid or nodules are common symptoms, and manifest as hard nodules of the thyroid, which can move up and down when swallowing. Radiation exposure, viral infection, or family inheritance can all be the triggers for DTC, especially for people with a history of radioactive exposure, and the risk of disease is significantly increased (11). DTC accounts for more than 90% of thyroid cancers.…”

Section: Discussionmentioning

confidence: 99%

Effects of laparoscopic and traditional open surgery on the levels of IL-6, TNF-α, and Gal-3 in patients with thyroid cancer

Qing²,

et al. 2021

Gland Surg

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Background: Traditional open surgery and laparoscopic surgery are common treatments for thyroid cancer patients, this paper aims to explore their effects on the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and galectin-3 (Gal-3) in patients with thyroid cancer. Methods:The clinical data of patients with thyroid cancer who received surgery in our hospital from September 2017 to February 2020 were collected. In total, 106 cases that met the inclusion and exclusion criteria were included. The patients were then allocated into two groups according to the surgery received, including a study group (56 cases treated with endoscopy) and a basic group (50 cases treated with traditional open surgery). Rehabilitation indicators and inflammatory cytokines were compared between the two groups.Results: There was no significant difference in the number of intraoperative lymph node dissections (P>0.05), postoperative complication rate (16.08% vs. 20.00%, P>0.05), and 6-month rate of recurrence or metastasis (P>0.05) between the two groups. Compared to the basic group, the operation time of the study group was longer, while the amount of intraoperative blood loss, 24 h drainage of the catheter and the length of hospital stay were significantly lower in the study group (P<0.05). The pain scores of the study group at 24 and 48 h after surgery were significantly lower than those of the basic group (P<0.05). The levels of IL-6, TNF-α, Gal-3, and other inflammatory factors in the two groups increased on the first day postoperatively, however the levels of these factors in the study group were lower than those in the basic group (P<0.05).Finally, the postoperative cosmetic satisfaction rate of the study group (94.64%) was higher than that of the basic group (86.00%), and the difference was statistically significant (P<0.05). Conclusions:The use of laparoscopic treatment can reduce the amount of intraoperative blood loss in patients with thyroid cancer, effectively reduce the degree of postoperative pain, and inhibit postoperative inflammation in the patient to a certain extent. Moreover, laparoscopic treatment can increase postoperative cosmetic satisfaction, reduce the occurrence of postoperative complications and recurrence rate, and improve the patient's prognosis.

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Less is More: The Impact of Multidisciplinary Thyroid Conference on the Treatment of Well‐Differentiated Thyroid Carcinoma

Cited by 13 publications

References 31 publications

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines

Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma

Effects of laparoscopic and traditional open surgery on the levels of IL-6, TNF-α, and Gal-3 in patients with thyroid cancer

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